Oxford Textbook of Public Health, Marcia Hills and Simon Carroll
By: Izzeldin F. Adam, BPEH, MPH
Department of International Health, TMDU

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Concept and definitions
Health education
Beliefs and approaches in health promotion
Health promotion strategies and priority
actions
Public health, social movement, health
inequity and millennium goals
Canadian experience in health promotion
Conclusion

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health promotion is centered on the values and
principles of equity, participation, and
empowerment.
health promotion must be much more active in
supporting the global efforts to address equity in
health and development represented on
the UN's MDGs
WHO's Commission on the Social Determinants of
Health

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„the process of enabling people to increase control
over, and to improve their health‟ (WHO,1986)‟.
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„Health promotion represents a comprehensive
social and political process, it not only embraces
actions directed at strengthening the skills and
capabilities of individuals, but also action directed
towards changing social, environmental and
economic conditions so as to alleviate their impact
on public and individual health. Health promotion is
the process of enabling people to increase control
over the determinants of health and thereby
improve their health (WHO 1998)‟.

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Any intentional activity which is designed to
achieve health or illness-related learning, that
is, some permanent change in an individual's
capability or disposition‟ (Tones 2004: 7).
Freire proposes that the main strategy of
empowerment education, critical dialogue, requires
us to engage in a process of problem posing rather
than a process of problem solving.

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All people have strengths and are capable of determining their own needs, finding
their own answers, and solving their own problems.
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Every person and family lives within a social-historical context that helps shape their
identity and social relationships.
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Diversity is positively valued.
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People without power have as much capacity as the powerful to assess their own
needs (people are their own experts).
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Relationships between people and groups need to be organized to provide an equal
balance of power (professional/client ).
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The power of defining health problems and needs belongs to those experiencing the
problem.
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The people disadvantaged by the way that society is currently structured must play
the primary role in developing the strategies by which they gain increased control over
valued resources.
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Empowerment is not something that occurs purely from within (only I can empower
myself), nor is it something that can be done to others (we need to empower the
group).
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Shared power relations do not deny health professionals their specialized expertise
and skills.

Approach
medical
Behavioral
Socio-ecological
Health
concept
Biomedical;
absence of disease
or disability
Individualized;
physical-functional
ability; physical
well-being
Positive state; connectedness;
ability to do important things;
psychological well-being
Health
determinants
Disease categories, Behavioral risk
physiological risk
factors (unsafe sex)
factors (hyper.)
Psychological risk factors
(isolation); socioenvironmental risk condition
(poverty)
Principle
strategy
Surgery; drug
therapy; illness
care; medically
managed
behavioral change
Advocacy for
healthy life style
choices
Personal empowerment; small
groups development;
community organization ;
coalition advocacy, political
action
Program
development
Professionally
managed
Negotiated with
individuals
communities and
professional
Managed by community in
critical dialogue with
supporting professionals and
agencies

1.
Advocacy for health to create the essential
conditions for health;
2.
enabling all people to achieve their full health
potential; and
3.
mediating between the different interests in
society in the pursuit of health

Strengthen
community
action
Create
supportive
environments
3
2
Build healthy
public policy
1
Develop
personal
skills
4
Health
promotion
5
Re-orient
health
services

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policy action must come from policy
sectors other than health but the
health sector would play a role in
public policy action. how?
Healthy public policy requires the
coordinated use of all policy levers
available, including „legislation,
fiscal measures, taxation, and
organizational change.
Healthy public policy requires the
identification and removal of
obstacles to the adoption of healthy
public policies in non-health sectors

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National health policy for food and
drugs
National health policy for protection
of water and environment
National health policy for health care
and health insurance.
National health policy for social
insurance, equity and social justice.
National policy for socio-economic
development.
National policy for health promotion
National policy for ……etc.

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Both the natural and built environments
are inextricably linked with people's
health.
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It involves creating conditions that allow
people to have „living and working
conditions that are safe, stimulating,
satisfying, and enjoyable.
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both past endeavors and future
prospects, one must take into account
the lofty ambition of this programme of
action (HIA, EIA)

strengthening the capacity of
people as active citizens through
their community groups,
organizations and networks to
address and prioritize their
problems, shape and determine
change in their communities.
 The foundational principles for
community development are:
• Empowerment
• Community competence
• Participation
• Issue selection
• Creating „critical consciousness‟
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Supporting personal and
social development through
providing information,
education for health, and
enhancing life skills.
 while we must be vigilant
against the temptation and
limitations of an individually
focused, skills development
approach, we must also reengage with the most
advanced and progressive
elements in this area of work.
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Breast Self-Examination
Testicular Self-Examination
Digital measuring for blood pressure

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universal access to health services (universality)
and the removal of barriers to access such as,
geographic, social, economic, or cultural
(accessibility);
It demands community participation in planning,
operation, and evaluation of health services
(participation);
It requires integration across health and other
sectors such as housing, education, and
employment;
It recognizes the power of multi-disciplinary
teams working as equal partners for the health of
the community;
It focuses on a range of services, determined by
the community, that include health promotion,
primary prevention, rehabilitative, and curative
(essentiality); and,
It demands a commitment to equity concerning
issues of power and resources (equity and access

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The more recent emphasis on health in the context
of globalization makes the necessity for health
promotion to engage with larger social movements,
particularly on the global development agenda, even
more apparent.
Health promotion suspended between its
constitutive desire to become one with the
„community‟ and its real position as a mediating
professional fraction, often acting on behalf of
formal public institutions.

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Health Promotion Glossary describes what equity in
health entails: „That all people have an equal
opportunity to develop and maintain their
health, through fair and just access to resources for
health‟.
Health promotion must fully engage with recent work
in political philosophy, particularly in the arguments
surrounding the concept of social justice
As health promoters, charged with the responsibility
to advocate, enable, and mediate for equity in
health, we should be armed with the very best
arguments supporting our position.

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(MDGs) adopted by all UN Member States in 2000,
have become a universal framework for
development and a vehicle by which low- and
middle-income countries and their development
partners can work together „in pursuit of a shared
future for all.
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In year 2005, the preventative health inequities
reported are overwhelming and their impact is
devastating. Even more discouraging is a call within
the report for high-income countries to scale up
their response if we are to have any hope of
meeting these goals.

focus on health promotion, disease prevention and
population health status
 place greater emphasis on community-based rather
than institutional care
 decentralize and regionalize the health care system
 emphasize primary care and move away from fee-forservice structures
 place greater emphasis on self-care and personal
responsibility for health maintenance.
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In year 1978,the federal Directorate of Health
Promotion was created.
In the late 1980s and early 1990s, health
promotion gained considerable acceptance within
the academic community.
In the early 1990s, a new construct—entitled
population health—began to replace health
promotion in many government and health policy
circles.
The “Healthy Community” and “Strengthening
Community Health” Initiatives The “Healthy
Cities/Communities” movement originated in
Canada and was implemented in 1986.

5th international
conference on
health promotion
(Mexico,2000)
6th international
conference on
health promotion
1st international
conference on
health promotion
(Ottawa,1986)
4th international
conference on
health promotion
7th international
conference on
health promotion
(Nairobi,2009)
2nd international
conference on
health promotion
3rd international
conference on
health promotion
(Adelaide,1988)
(Sundsvall,1991)
Lalonde report
1974
(Jakarta,1997)
(Bangkok,2005)
8th
Where, when, why?

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Health promotion is a complex, often ambiguous
concept and set of practices. It has an intimate
connection with health education and has its roots
in the deep history of public health.
The foundational principles of health promotion are
equity, participation, and empowerment.
Health promotion must take its duty to enable
people to control the determinants of their health
seriously.
To achieve its goals health promotion must engage
directly with political philosophy and it must be
aware of the dynamics of the global political
economy and its effect on health.