THEORYOF HEALTH

PROMOTION
Healthcare 2 Lecture
Zyra Mae F. Villamor, MOH, PTRP

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CONCEPTS OF HEALTH
Health, Disease, Illness and Ill-health

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  “Hael” (Old English)  whole concerns the whole
person and his or her integrity, soundness and well
– being.
 Two Common Meanings:
1. Negative Definition of Health
- Health is the absence of disease or illness
Health
2. Positive Definition of Health
-WHO
- a state of complete physical, mental and
social well-being, not merely the absence of
disease

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  Quality of life
 A general satisfaction
in all areas of the
individual’s life,
Wellness including aesthetic,
cultural, educational,
economic, emotional,
environmental,
mental, physical,
relational and spiritual

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  Symptom experience (physical, cognitive,
emotional)
 Assumption of the sick role (confirmation from
family members)
Stages of
 Medical care contact (seek professional health
Illness services)
(Schumann)  Dependent patient role (dependent on health
practitioner for relief of symptoms, accepts care)
 Recovery or rehabilitation (return to previous
function, adjust to prolonged reduction in function)
  DISEASE
- “desaise”  Uneasiness and Discomfort
- an objective state of ill health, which may be
verified by accepted canons of proof.
Disease - the existence of some pathology or
Illness abnormality of the body which is capable of
detection.
Ill Health  ILLNESS
- subjective experience of loss of health.
 ILL HEALTH
- when disease and illness coincide

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 SOCIETAL

Physical Mental

Dimensions
Emotional Social
of Health

Spiritual Sexual

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 Inner Circle Definition
Physical Health Concerns the body
Mental Health Positive sense of purpose and underlying
belief in one’s worth.
Emotional Health Ability to feel, recognize and give voice to
Dimensions feelings and to develop and sustain
relationships.
of Health Social Health Sense of having support from family and
friends
Spiritual Health Recognition and ability to put into practice
moral and religious principles or beliefs and
the feeling of having a purpose in life
Sexual Health Acceptance and ability to achieve a
satisfactory expression of one’s sexuality.

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 Outer Circle Definition
Societal Health Link between health and the way the
society is structured
Includes structures necessary for health
and the degree of integration and division
within the society.
Environmental Physical environment in which people live
Dimensions Health and the importance of good – quality
housing, transport, sanitation and pure
of Health water facilities and involves caring for the
planet and ensuring its sustainability
Global Health -----

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INFLUENCESON
HEALTH
Determinants of Health
Measurement of Health

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  The determinants of health include:
 the social and economic environment,
 the physical environment, and
 the person’s individual characteristics and
behaviours.

Determinants Of
Health

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  Income and social status - higher income and
social status are linked to better health. The greater
the gap between the richest and poorest people,
the greater the differences in health.
 Education – low education levels are linked with
poor health, more stress and lower self-confidence.

Determinants Of
Health

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  Physical environment – safe water and clean air,
healthy workplaces, safe houses, communities and
roads all contribute to good health. Employment
and working conditions – people in employment
are healthier, particularly those who have more
control over their working conditions
 Social support networks – greater support from
families, friends and communities is linked to better
Determinants Of health. Culture - customs and traditions, and the
Health beliefs of the family and community all affect
health.

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  Genetics - inheritance plays a part in determining
lifespan, healthiness and the likelihood of
developing certain illnesses. Personal behaviour
and coping skills – balanced eating, keeping active,
smoking, drinking, and how we deal with life’s
stresses and challenges all affect health.
 Health services - access and use of services that
prevent and treat disease influences health
Determinants Of  Gender - Men and women suffer from different
Health types of diseases at different ages.

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  Reasons for Measuring Health:
1. To establish priorities.
2. To assist planning
3. To justify resources
Measurement 4. To assist in the development of the profession

of Health  Ways of Measuring Health:

1. Measuring health as a negative variable
2. Measuring health as an objective attribute
3. Measuring deprivation
4. Subjective health measures

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HEALTH PROMOTION
Foundation of Health Promotion
Levels of Healthare
Health Promotion Strategies

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  Process of enabling people to increase control over
determinants of health and thereby improve their
health.
 Foundations (Alma Ata Conference in 1978)
1. A change in perception of the determinants of
Foundations Of health and shift away from the tendency to
Health equate health simply with healthcare services.
Promotion 2. The shift from communicable diseases to chronic
diseases attributable to people’s lifestyle.
3. An awareness of the potential of primary
healthcare as a first line for prevention and
treatment.

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 PRIMARY HEALTHCARE (WHO 1978, Alma Ata
Declaration)
 PHC seeks to extend the first level of health
system from sick care to the development of
health. It seeks to protect and prevent the
Primary Healthcare problems at an early stage.
And Health Promotion
 PHC services involves continuity of care, health
promotion and education, integration of
prevention with sick care, a concern for population
as well as individual health, community
involvement and the use of appropriate
technology.

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  Approach to PHC is characterized by the following:

1. A holistic understanding of health as well being

rather than the absence of the disease.
2. Recognition that the presence of good health is
Primary Care dependent on the multiple determinants; health
services is important but so too are housing,
Principles education, agriculture etc.
3. Health services reflect local needs
4. Services and technology are affordable
accessible and acceptable to communities
5. Health services strive to address inequity and
prioritize services to the most needy.

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  PRIMARY PREVENTION
 Seeks to avoid the onset of ill health by detection of
high – risk groups and the provision of advice and
counseling.

 SECONDARY PREVENTION
Levels Of  Seeks to change health – damaging behavior to
Healthcare shorten episodes of illness and prevent progression
of ill health

 TERTIARY PREVENTION
 Seeks to limit disability or complications arising
from chronic or irreversible condition and enhance
the quality of life.

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 “ Health is created and lived by people within the
Settings For settings of their everyday life: where they learn,
work, play and love”
Health
Promotion - Ottawa Charter, 1986
- World Health Organization

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  SCHOOL
 Reaches a large proportion of the population for
many years
 Emphasis on schools is also a recognition that the
learning of health – related knowledge, attitudes
and behavior begins at an early stage

Settings For
Health
Promotion

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  WORKPLACE
 Significant in affecting people’s health and as a
context in which to promote health.
 Most interventions focus on individual lifestyle risk
factors and employer’s legal responsibilities to
provide a safe working environment.
 Less common but are more effective

Settings For
Health
Promotion

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  NEIGHBORHOOD / COMMUNITY
 Small localities with a distinct identity by a
community of people who know each other and the
provision of essential services ( post office, health
centers etc. ).
Settings For
Health  Where the physical and social environments
Promotion interact with service provision to provide an over-all
environment which has enormous potential to
support health.

 Addressing the core determinants of health .

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  HOSPITALS

“ A health – promoting hospital does not only provide

high quality comprehensive medical and nursing
services but also develops identity that embraces the
Settings for aims of health promotion, develops a health –
Health promoting organizational structure and culture,
Promotion including active, participatory roles for patients and
all members of staff, develops itself to a health –
promoting physical environment and actively
cooperates with its community”
- WHO, 1998

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 Health Education and Promotion Strategies:
 Communication Strategies
1. Interpersonal
 Counselling
 Group discussion- most participatory
2. Mass Media
Teaching And  Limited Reach media
Learning  Mass reach media
Strategies  Training
 needs assessment, formulation of goals and objective,
plans and design, implementation, evaluation

 Community organizing

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HEALTH PROMOTION
IMPLEMENTATION

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  Good Health Promotion Practice depends on:
1. Adherence to core health – promoting principles
Health 2. Personal Skills and Training
Promotion 3. Use of suitable models and frameworks to guide
Implementation action
4. Systematic and structured approach to
intervention

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  Health – Promoting Principles:
1. Empowering
2. Participatory
Health
3. Equitable and guided by a concern for social
Promotion justice
Implementation 4. Intersectoral
5. Sustainable
6. Multistrategy

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 Most assessment and planning frameworks include
steps or phases that reflect the following actions,
some of which may occur simultaneously:
1. Organize and plan
2. Engage the community
Health 3. Develop a goal or vision
Promotion 4. Conduct community health assessment(s)
Implementation 5. Prioritize health issues
6. Develop community health improvement plan
7. Implement and monitor community health
improvement plan
8. Evaluate process and outcomes

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ASSESSING HEALTH
NEEDS
First Phase in Health Promotion Planning

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  Reports about a community or target population
within a community.
 Requires the use of an organized procedure to
identify, gather, examine and analyze data of the
Community interest to the group.
Health Needs  5 Common Methods:
Assessment 1. Focus Groups
2. Interviews with key informants
3. Traditional Survey Methodology
4. Secondary Analysis of existing data
5. Geographic Information Systems

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  Interviews with small homogenous group of
individuals usually community members using open
– ended questions.
 Use in Needs Assessment:
1. Determine the expressed felt needs and wants of
a specific community.
2. Provides qualitative insights that cannot be
derived from written questionnaires

Focus Groups

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  Interview with individuals recognized as having
specific experience or expertise.
 Semi-structured interview questionnaire or outline
guide questions and encourages informants to
share personal perspectives.
Key Informant  Key informant is asked to recommend other key
Interviews informants (Snowball Sampling)
 Use in Needs Assessment:
1. Provide information and insights to the needs of
the community or a specific group.
2. Allows interviewers to maximize the number of
information – rich key informants over a short
period of time.

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  Gathers data from a small sample that is
representative of a larger population.
 Uses interview schedule or outline of questions.
Traditional  Can be done by phone, internet, mail or personal
interview
Survey
 Use in Needs Assessment:
1. Used to study a population
2. Determines expressed, normative, felt and
comparative needs of specific population groups.

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  Identifying, gathering, grouping and analyzing
existing data from VALID sources.
 Use in Needs Assessment:
Secondary 1. Focus groups, key informant interviews describe,
Analysis of illustrate, validate and enrich the data gathered
from existing data.
Existing Data 2. Especially useful for comparing sample
characteristics.
3. Useful when time and financial resources are
limited.

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  Uses computerized program for identifying,
locating, storing, integrating, mapping, analyzing
and illustrating data related to geographical
locations.
Geographic
Information  Use in Needs Assessment:
Systems 1. Technology provides the best use of limited
resources.
2. Map large areas.
3. Data can be layered to provide rich descriptions of
needs and resources.

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