Health Promotion has practical focus on health and well being
A main feature of the discipline is its recognition that health is more than individual physical and mental well-being or fitness, but incorporates overall social factors such as the degree of equality and social support. The concept of health is very complex, therefore health promotion draws upon many different strategies and disciplines to improve the health of individuals and communities and the population on the whole, these may include sociology, social psychology, education and communication, economics, ethics and epidemiology (Bunton and MacDonald, 1992). The concept of health promotion is exceptionally broad and appears to include any attempt to improve health.
The term was first introduced in 1974 by the Canadian Minister of Health, Marc Lalonde, who suggested that there where different elements that contributed to the public’s health. (Marc Lalonde 1974) believed these to be, human biology (genetics and hereditary factors), lifestyle (personal behaviours that may contribute to health or illness, for example those related to exercise and diet), environment (including both physical and social environment in which people lived and worked), health care organisation (the quality and availability of health services).
The main and most radical feature of this report was the belief that an improvement in health would come not from a greater expenditure on health services for those who are sick but from a “new perspective” that directed money to prevention. The arguments for this new approach were compelling. In the developed world it was apparent that technological medicine and hospital-based services were not reducing the burden of ill health.
Major causes of mortality in developed countries are non-communicable diseases such as heart disease, cancer and respiratory illness, whose cause can be attributed to behaviours such as smoking and nutrition. There is a growing elderly population, which is associated with an increased demand for care, although older people remain independent and living in the community. Curative medicine involves escalating costs with no guarantee of effectiveness along with the fact that people’s expectations of health services outstrip capacity.
The diversity of practice in health promotion has identified a need for an outline or containment that will accommodate the very different determinants of health and the consequent range of interventions. (Rawson and Grigg 1988) identified 17 publicised health education models in the U. K. and more have been published since. The use of models enables health promotion to be mapped and identify underlying theoretical perspectives. Tannahills model describes health promotion as three intersecting circles of health education, prevention and health protection.
Within these intersecting circles lie seven possible dimensions of health promotion. An example of preventative services could be immunisation and cervical screening. Preventative health education may be delivered as advice given for cessation of smoking. Preventative health protection may include the fluoridation of water. Health education for preventative health protection for example may include the lobbying for the use of seat belts. Positive health education could be delivered by advice given for the building of life skills with groups.
Positive health protection may be the implementation of a workplace smoking policy. Health education aimed at positive health protection might be implemented by the campaigning for protective legislation. Tannahills model highlights the fact that practice does not conform to theoretical boundaries but overlaps and spans different theoretical paradigms simultaneously. (Tannahill, 1985) Beatties model of health promotion relates more directly to social theories and demonstrates how health promotion practise can never be value free but is underpinned by values and moral principles.
Beatties model uses two axis to generate four quadrants. The vertical axis runs from authoritative (expert-lead) interventions, these interventions are typically based on an objective knowledge of health risks, leading to negotiated interventions that recognise the use of peoples “lay” knowledge of health. Activities may be traditionally authoritative and hierarchical in nature or more egalitarian and negotiable. The horizontal axis runs from activities aimed towards individuals to activities aimed towards whole populations.
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