Health
Promotion
Amer Eltwati Ben Irhuma,*
Prevention of disease in society has
always been the focus of public health. However, over the past 30 years, health
promotion has moved to the forefront within the public health sector and has
become a driving force in health care.1,2
Health promotion is a relatively new field;
therefore, its definitions vary. O'Donell has defined health promotion as
"the science and ant of helping people change their lifestyle to move
toward a state of optional health".3
Kruter and Devore propose a more
complex definition in a paper commissioned by the U.S. Public Health Service.
They state that health promotion is the "process of advocating health in
order to enhance the probability that personal (individual, family, and community),
private (professional and business) and public (federal, state, and local
government) support of positive health practices will become a societal
norm".4
The theoretical underpinnings for
health promotion have evolved since the early 1980s. Most of these theories are
derived from the social sciences and have been researched extensively.5-8
Of particular interest to the physician
are the most recent works by Bandura on self-efficacy and Pender and Co-workers
on the health promotion model.7,8
Health promotion goes beyond providing
information. It is also provactive decision making at all levels of society. A
few of the strategies that have been identified within this decision making
process are screening, self-care of minor illness, readiness for emergencies,
successful management of chronic disease, environmental changes to enhance
positive behaviours, and health-enhancing policies within an organizational
setting.9
These ideals are reflected in the
Healthy People 2010 objectives [Boxes
1 -
Selected
National Health Promotion and Disease Prevention Objectives
for
Nutrition and Overweight.
|
· Increase the
proportion of adults who are at a healthy weight.
· Reduce the
proportion of adults who are obese.
· Reduce the
proportion of children and adolescent who are overweight or obese.
· Increase the
proportion of people aged 2 years and older who consume at least two daily
servings of fruit.
· Increase the
proportion of people aged 2 years and older who consume at least three daily servings
of vegetables, with at least one third being dark green or deep yellow
vegetables.
· Increase the
proportion of people aged 2 years and older who consume at least six daily
servings of grain products, with at least one third being whole grains.
· Increase the
proportion of people aged 2 years and older who consume less than 10% of
calories from saturated fat.
· Increase the
proportion of people aged 2 years and older who consume no more than 30% of
calories from fat.
· Increase the
proportion of people aged 2 years and older who consume 2400 mg or less of
sodium daily.
|
*)
Professor and Head Surgical Department, Dean, Faculty of Medicine, Sebha University ,
Sebha , Libya
|
· Physical
activity.
· Overweight
and obesity.
· Tobacco use.
· Substance
abuse.
· Responsible
sexual behavior.
· Mental
health.
· Injury and
violence.
·
Environmental quality.
·
Immunization.
· Access to
health care.
|
|
· Health education.
· Good standard of nutrition
adjusted to developmental phases of life.
· Attention to personality
development
· Provision of adequate
housing, recreation, and agreeable working conditions.
· Marriage counseling and sex education.
· Genetic screening.
· Periodic selective examinations.
|
Health
promotion holds the best promise for lower-cost methods of limiting the
constant increase in health care costs and for empowering people to be
responsible for the aspects of their lives that can enhance wellbeing. Based on
the significance of health promotion activities within the health system,
efforts must be made to identify the determinants of health, identify relevant
health-promotion strategies, and delineate issues relevant to social justice
and access to care. Individuals, families, and communities must be active
participants in this process so that the actions taken are socially relevant
and economically feasible.
Health
promotion efforts, unlike those specific efforts directed toward protection
from certain diseases, focus on maintaining or improving the general health of
individuals, families, and communities. These activities are carried out at the
public level (e.g. government programs promoting adequate housing), at the
community level (e.g. Habitat for Humanity), and at the personal level (e.g.
voting for improved low-income housing).
Two strategies
of health promotion involve the individual and may be either passive or active.
In passive strategies the individual is an inactive participant or recipient.
Examples of passive strategies include public health efforts to maintain clean
water and sanitary sewage systems to decrease infectious disease rates and
improve health and efforts to introduce vitamin D into all milk to ensure that
children will not be at high risk for rickets when there is little sunlight.
These passive strategies must be used to promote the health of the public when
individual compliance is low.
Active
strategies depend on the individual becoming personally involved in adopting a
program of health promotion. Two examples of life-style change are daily
exercise as part of a physical fitness plan and a stress-management program as
part of daily living. A combination of active and passive strategies is best
for making as individual healthier.
Although health
promotion would seem to be a practical and effective mode of health care, the
major portion of health care delivery is geared toward responding to acute and
chronic disease. Preventing or delaying the onset of chronic disease and adding
new dimensions to the quality of life are not as easy to implement, because
they take time to implement and evaluate and require personal action. These
actions are more closely associated with everyday living and the lifestyles
adopted by individuals, families, communities, and nations. Habits such as
eating, resting, exercising, and handling anxieties appear to be transmitted
from parent to child and from social group to social group as part of a
cultural, not a genetic, heritage. These activities may be taught in subtle
ways, but they influence behavior and have as much of an influence on health as
does genetic inheritance. Although the public may not appreciate the causal
relationships between behavior and health, it should be apparent to health professionals.
Arguably, the concept of risk is the most basic of all health concepts, because
health promotion and disease protection are based on this concept.
Health-promotion
strategies have the potential of enhancing the quality of life from birth to
death. For example, good nutrition is adjusted to various developmental phases
in life to account for rapid growth and development during infancy and early
childhood, physiological changes associated with adolescence, extra demands
during pregnancy, and the many changes occurring in older adults. Good
nutrition is known to enhance immune system function, enabling individuals to
fight off infections that could lead to disabling illnesses.
Other
individual activities are adopted to the person's needs for optimal personality
development at all ages. As seen, much can be done on a personal or group
basis, through counseling and properly directed parent education, to provide
the environmental requirements for the proper personality development of
children. Community participation is also an important factor in promoting
individual, family, and group health.
Personal health
promotion is usually provided through health education. As an important
function of physician, nurses and allied health professionals, health education
is principally concerned with eliciting useful changes in human behavior. The
goal is the inculcation of a sense of responsibility for an individual's own
health and a shared sense of responsibility for avoiding injury to the health
of others. This objective implies the encouragement of child-rearing practices
that foster normal growth and development (personal, social and physical).
Health education nurtures health-promoting habits, values and attitudes that must
be learned through practice. These must be reinforced through systematic
instruction in hygiene, bodily function, physical fitness and use of
leisure-time. Another goal is to understand the appropriate use of health
services. For example, a semiannual visit to a dentist may teach a child better
oral health habits and to visit the dentist regularly, although this is not the
primary purpose of the visit. Parents, teachers, and caregivers play a vital
role in health education.
Research
clearly shows an increase in longevity, a decrease in early mortality and
morbidity, and an improvement in the quality of life for individuals who have
been involved in health-promotion activities such as physical activity and
avoidance of smoking. It must be emphasized that health promotion requires
lifestyle changes. Once a lifestyle change has been adopted, vigilance is
needed to ensure that it is maintained and modified to fit development and
environmental changes.10
Acknowledgement:
Technical
assistance of Mr. Hussein El Jamal at African Computer
Center
References:
1. Li S. Department of Health Education
and Welfare, public Health Service. Healthy People, Washington D.C. US
2. Edelman C.L. and Mandle C.L. Health
Promotion throughout the life spam. Mosby ,
New York
3. O'Donnell M. Definition of health
promotion. American Journal of Health Promotion. 1987; 1: 4.
4. Kreuter M. and Devore R. Update:
Reinforcing the case for health promotion. Family and community health. 1980;
10: 106.
5. Alzen A. and Fishbein M.
Understanding attitudes and predicting social behavior. Upper Saddle
River
6. Bandura A. Social learning theory. Upper Saddle
River
7. Bandura A. Self-efficacy. The
exercise of control. New York
8. Pender N.J., Murdaugh C.L. and
Parson M.A. Health promotion in nursing practice. Upper River
9. Folding J. The proof of the health
promotion pudding. Journal of Occupational Medicine, 1988; 30: 113.
10. Nigg C.R., Burbank P., Padula C. et
al. Stages of change across ten health risk behaviours for older adults. The
Gerontologist, 1999; 32: 472-482.
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