1. Amany R.Abo-El-Seoud
Amany R.Abo-El-Seoud
Prof. Of Community Medicine
Prof. Of Community Medicine
Zagazig University,EGYPT
Zagazig University,EGYPT
HEALTH PROMOTION
HEALTH PROMOTION

2. Health promotion
Health promotion
It is the science aiming at reaching optimal
(perfect) health
All activities aiming at increasing well-being,
prevention of disease and health hazards,
or control of disease are included under
health promotion. (it is the highest aim of CM)
Health promotion is to add
Health promotion is to add ‘
‘life into the
life into the
years
years’
’ and not just add
and not just add ‘
‘years onto life
years onto life’
’

3. Definition of health promotion
Definition of health promotion
Is a process of activating communities,
Is a process of activating communities,
policy makers, professionals and the
policy makers, professionals and the
public in favor of health supportive
public in favor of health supportive
policies, systems and ways of living.
policies, systems and ways of living.
It is carried out through acts of advocacy,
It is carried out through acts of advocacy,
empowerment of people and building
empowerment of people and building
social support systems that enable people
social support systems that enable people
to make healthy choices and live healthy
to make healthy choices and live healthy
lives.
lives.

4. The basic principles for health
promotion:
Promotion of health requires a secure foundation in
these basic prerequisites.
Sustainable
resources
Peace
Shelter
Education
Food
Income
A stable
ecosystem
Health
• Social justice & equity

5. Advocate for health:
- Good health gives better quality of life so it
necessitates advocacy (fighting for it).
- The following factors can favor health or can harm it:
- Health promotion aims at making these conditions
favorable for health.
Political conditions
Economic conditions
Social conditions
Cultural conditions
Environmental factors or conditions
Behavioral factors or conditions
Biological factors or conditions
Health

6. Approaches for health promotion
Approaches for health promotion
How can we promote health?
How can we promote health?
 Healthy population (infrastructure)
Healthy population (infrastructure)
 Healthy lifestyle
Healthy lifestyle
 Healthy environment
Healthy environment

7. 1
1
-
-
Healthy populations
Healthy populations
By targeting all life stages and groups.
By targeting all life stages and groups.
Since the health needs of people vary
Since the health needs of people vary
according to their stage in the life cycle or
according to their stage in the life cycle or
their gender, the healthy population
their gender, the healthy population
approach encourages initiatives that focus
approach encourages initiatives that focus
on the health needs and contributions of
on the health needs and contributions of
people at every life stage.
people at every life stage.

8. 2
2
-
-
Healthy lifestyles
Healthy lifestyles
This approach focuses more on the
This approach focuses more on the
behavior of individuals and how their
behavior of individuals and how their
decisions and actions can lead to healthier
decisions and actions can lead to healthier
outcomes. This can be done through
outcomes. This can be done through
health education, social mobilization and
health education, social mobilization and
advocacy programs.
advocacy programs.
No smoking, better nutrition and exercise
No smoking, better nutrition and exercise
are examples of healthy lifestyles
are examples of healthy lifestyles
approach.
approach.

9. 3
3
-
-
Healthy settings
Healthy settings
Creating social, economic and
Creating social, economic and
environmental conditions that are
environmental conditions that are
favorable to good health. Health
favorable to good health. Health
conditions in developing countries must be
conditions in developing countries must be
viewed in a wider socio economic context
viewed in a wider socio economic context
because millions of people are trapped in
because millions of people are trapped in
the vicious cycle of poverty, despair,
the vicious cycle of poverty, despair,
disparity, illiteracy and disease
disparity, illiteracy and disease

10. Other approach for health
Other approach for health
promotion
promotion
Prevention
Immuniz
.
Environment
H.Services
Protection
Laws&policy
Health education
Appreciate health
Keen to keep healthy

11. Who promote health?
Who promote health?
Individual role Governmental role
Legislation
Environmental health
Health services
Other ministries
Policy & budget
H.Conciousness
Life style
Genetic
Beliefs
Occupation

12. WHO PROMOTES
WHO PROMOTES
HEALTH
HEALTH
?
?
 International organization
International organization
 Health authorities
Health authorities
 Non-Governmental Organizations
Non-Governmental Organizations
 Primary health care team
Primary health care team
 Private physician.
Private physician.
 Other health professions: nurses,
Other health professions: nurses,
professions allied to medicine.
professions allied to medicine.
 Religious organizations
Religious organizations

14. Guiding Principles of Health
Guiding Principles of Health
Promotion
Promotion
 Empowering
Empowering individuals and communities.
individuals and communities.
 Participatory
Participatory (involving all).
(involving all).
 Holistic
Holistic (all four dimensions of health).
(all four dimensions of health).
 Intersectoral
Intersectoral (collaboration of all agencies)
(collaboration of all agencies)
 Equitable
Equitable (equity and social justice)
(equity and social justice)
 Sustainable
Sustainable (changes are maintained)
(changes are maintained)
 Multistrategy
Multistrategy (variety of approaches)
(variety of approaches)

15. Health promotion "23 years of
continuous development
"
- Ottawa (Canada) 1986:
→ first international health promotion
conference as an extended application for the
Alma Ata declaration 1978 on primary health
care.
- Australia 1988:
→ Concept of healthy public policy being a
human right. gender dimension was given
specific attention.
- Sweden 1991:
→ Concept of supportive environments
conductive to health and the links with
sustainable development.

16. -Jakarta, Indonesia 1997:
Issues related to globalization (the potentials
and controversies around public-private
partnership) infra-structures and funding.
- Mexico city, Mexico 2000:
→ High level political commitment to health
promotion.
Positioning health promotion higher on the
political agenda and recognizing it as a priority
in local, regional, national, and international
programs.
- Bangkok (Thailand) 2005:
Identified major challenges, actions &
commitments needed to address the
determinants of health in the world by reaching
out to people, groups & organizations that are
critical to the achievement of health.

17. Ottawa Charter put five
action areas for promotion
:
1- Develop healthy public policy.
2- Create supportive environment
for
health
3- Strengthen community action.
4- Develop personal skills i.e.
modifying their life style towards
healthy behaviors.
5- Reorient health services.

18. 1
1
-
-
Develop healthy public policy
Develop healthy public policy
health should be on the policy agenda in all
health should be on the policy agenda in all
sectors, and at all levels of government.
sectors, and at all levels of government.
Governments are ultimately accountable to their
Governments are ultimately accountable to their
people for the health consequences of their
people for the health consequences of their
policies, or the lack of policies. A commitment to
policies, or the lack of policies. A commitment to
healthy public policies means that governments
healthy public policies means that governments
must measure and report on their investments
must measure and report on their investments
for health, and the subsequent health outcomes
for health, and the subsequent health outcomes
of these investments and policies in a language
of these investments and policies in a language
that all groups in society readily understand.
that all groups in society readily understand.

19. 2
-
Create supportive
environment
:
(1) Protection and conservation of the
natural environment - as a natural
resource - must be addressed in
any health promotion strategy.
(2)We must create a healthy working
& living conditions and making
them safe, stimulating for health,
satisfying & enjoyable.

20. (3) Systematic assessment of the
health impact of any rapidly
changing environment as in Work
places, energy production areas
and rapidly urbanized areas.
(4)Encourage research studies for
detection of environmental hazards
on health and methods of
controlling them.

21. 3
-
Strengthen community
action
 Health promotion depends on concrete &
effective community action.
The community has to share in:
• Setting priorities
• Making decisions
• Planning strategies
• Implementing these strategies

22. This can be enhanced by:
 • Empowering the community
 • Create ownership
 • Control of their actions & efforts
This requires:
 • Continuous access to information.
 • Learning opportunities for health.
 • Funding support.

23. 4
4
-
-
Health promotion strategies
Health promotion strategies
directed towards individuals
directed towards individuals
1.
1. Increase individual awareness of disease and
Increase individual awareness of disease and
disability prevention actions.
disability prevention actions.
2.
2. Changing lifestyles to healthy ones
Changing lifestyles to healthy ones
3.
3. Encourage individuals to have check-ups and
Encourage individuals to have check-ups and
to use health screening opportunities.
to use health screening opportunities.
4. Early seeking for medical advice
4. Early seeking for medical advice
5. Compliance to physician
5. Compliance to physician
instruction and treatment schedule
instruction and treatment schedule

24. 5
5
-
-
Reorient health services
Reorient health services
Health promotion requires reorientation of health
Health promotion requires reorientation of health
systems from tertiary (curative strategies) to
systems from tertiary (curative strategies) to
primary and secondary prevention models. This
primary and secondary prevention models. This
reorientation is often be resisted by doctors, and
reorientation is often be resisted by doctors, and
pharmaceutical companies and hospitals, those
pharmaceutical companies and hospitals, those
who adopt
who adopt ‘
‘find it and fix
find it and fix it
it’
’ approach.
approach.
Encourage health service providers to build
Encourage health service providers to build
opportunities for health education settings in
opportunities for health education settings in
primary and secondary prevention of disease
primary and secondary prevention of disease
and disability when delivering services.
and disability when delivering services.

25. Evaluation of Health promotion
Evaluation of Health promotion
activities in a community:
activities in a community:
By assessing:
By assessing:
1.
1. Quality of life indicators.
Quality of life indicators.
2.
2. Health knowledge, attitude, motivation
Health knowledge, attitude, motivation
and skills among population sectors.
and skills among population sectors.
3.
3. Social action and influence (community
Social action and influence (community
participation & public opinion).
participation & public opinion).
4.
4. Legislation, regulation for public health
Legislation, regulation for public health

26. 5- Resource allocation for health in relation to
5- Resource allocation for health in relation to
national budget.
national budget.
6- improved health indicators as morbidity &
6- improved health indicators as morbidity &
mortality
mortality
7- improved productivity, reduced absenteeism.
7- improved productivity, reduced absenteeism.
8- decrease in medical care utilization
8- decrease in medical care utilization
9- decrease in health care cost.
9- decrease in health care cost.
H. Promotion = h.education x healthy public policy
H. Promotion = h.education x healthy public policy

27. Problems facing health promotion
Problems facing health promotion
in developing countries
in developing countries
 Poverty
Poverty and consequently the poor living
and consequently the poor living
conditions (e.g. poor nutrition, poor housing,
conditions (e.g. poor nutrition, poor housing,
environmental degradation) associated with it
environmental degradation) associated with it
are major obstacle for improving health of
are major obstacle for improving health of
people in developing countries. Unless
people in developing countries. Unless
fundamental changes are made to this wider
fundamental changes are made to this wider
context it will be difficult to make major advances
context it will be difficult to make major advances
in health promotion.
in health promotion. The challenge of reducing
poverty cannot be underestimated.

28. Decision makers must find answers for
Decision makers must find answers for
these questions:
these questions:
1-How to draw more resources from the
1-How to draw more resources from the
community and individuals to meet the
community and individuals to meet the
health challenges they face?
health challenges they face?
2-How to direct health expenditures? Either
2-How to direct health expenditures? Either
for prevention or for control?
for prevention or for control?

29.  Economic priorities
Economic priorities
Most developing countries have limited resources and
Most developing countries have limited resources and
many competing demands for these resources. They are
many competing demands for these resources. They are
seeking to achieve rapid economic gains and
seeking to achieve rapid economic gains and
development by industrialization and food production
development by industrialization and food production
that gives priority to foreign markets for earning foreign
that gives priority to foreign markets for earning foreign
exchange.
exchange.
Insufficient attention is given to the needs of local citizens
attention is given to the needs of local citizens
leading to low wages and poverty, poor nutrition and
leading to low wages and poverty, poor nutrition and
worse environmental condition, all of which have serious
worse environmental condition, all of which have serious
health consequences. International donors tend to
health consequences. International donors tend to
encourage activities that promote economic
encourage activities that promote economic
development and have quick and visible outcomes.
development and have quick and visible outcomes.
The challenge for health promotion is to convince policy-
The challenge for health promotion is to convince policy-
makers that
makers that good health is an economic asset rather
good health is an economic asset rather
than a cost and it is an essential component of social
than a cost and it is an essential component of social
and economic empowerment
and economic empowerment

30.  Education
Education
Low levels of literacy specially health literacy
Low levels of literacy specially health literacy
provide another challenge for the health
provide another challenge for the health
promotion approach. This can be an obvious
promotion approach. This can be an obvious
problem when trying to promote better health
problem when trying to promote better health
behavior among people. Poor levels of
behavior among people. Poor levels of
knowledge is an important factor that contribute
knowledge is an important factor that contribute
to almost all diseases. Efforts done to improve
to almost all diseases. Efforts done to improve
illiteracy actually share in health promotion
illiteracy actually share in health promotion

31. Political stability
Political stability
:
:
Where there is political instability,
Where there is political instability,
internal conflict and war, it is extremely
internal conflict and war, it is extremely
difficult to develop health-promoting
difficult to develop health-promoting
environments. Not only are the economic
environments. Not only are the economic
resources and priorities of governments
resources and priorities of governments
directed elsewhere, but also the regulatory
directed elsewhere, but also the regulatory
environment to create health supportive
environment to create health supportive
settings is lacking.
settings is lacking.

32. Inter sectoral co-operation
Inter sectoral co-operation
:
:
Decision-makers in all sectors (even in
Decision-makers in all sectors (even in
areas that are indirectly related to health
areas that are indirectly related to health
as agriculture, commerce, education,
as agriculture, commerce, education,
industry etc) must focus on the health
industry etc) must focus on the health
implications of their policies, in fact, their
implications of their policies, in fact, their
competing priorities may lead them to
competing priorities may lead them to
disregard the health implications of their
disregard the health implications of their
decisions.
decisions.

33. Commercial interests
Commercial interests
Marketing does not necessarily consider
Marketing does not necessarily consider
health of citizens of developing countries
health of citizens of developing countries
uppermost in their priorities. This is often
uppermost in their priorities. This is often
result in poor health outcomes. For example
result in poor health outcomes. For example
marketing tobacco, and western food products.
marketing tobacco, and western food products.
Commercial propaganda of unhealthy products and
Commercial propaganda of unhealthy products and
lifestyles make it difficult for healthy choices to be the
lifestyles make it difficult for healthy choices to be the
easiest or the attractive choices
easiest or the attractive choices.
.
Regulation of the activities of these commercial interests is
Regulation of the activities of these commercial interests is
required through political rules to introduce sufficient
required through political rules to introduce sufficient
levels of regulation as the taxes gained from unhealthy
levels of regulation as the taxes gained from unhealthy
products and used as an important source of
products and used as an important source of
governmental funds. Poor governments can find it
governmental funds. Poor governments can find it
difficult to resist this source of revenue.
difficult to resist this source of revenue.

34. The double burden of disease
The double burden of disease
One of the particular challenges that face
One of the particular challenges that face
developing countries is that the epidemic
developing countries is that the epidemic
of non communicable disease is
of non communicable disease is
developing before the burden of
developing before the burden of
communicable (infectious disease) has
communicable (infectious disease) has
been dealt with. The difficulty faced by
been dealt with. The difficulty faced by
developing nations is to deal with these
developing nations is to deal with these
dual sources of disease without adequate
dual sources of disease without adequate
economic resources.
economic resources.

35. The speed of change
The speed of change
Populations in the developing
Populations in the developing
world are increasing at a much
world are increasing at a much
faster rate than countries in
faster rate than countries in
the developed world. It is
the developed world. It is
much easier for countries to
much easier for countries to
adjust to gradual population transitions than to
adjust to gradual population transitions than to
these rapid changes. Population increase at
these rapid changes. Population increase at
such a rate that all policy systems have not kept
such a rate that all policy systems have not kept
pace. The speed of the transition and the
pace. The speed of the transition and the
economic cost make it nearly impossible for d.
economic cost make it nearly impossible for d.
countries to provide all needs of citizens.
countries to provide all needs of citizens.

36. QUALITY OF LIFE QOL
QUALITY OF LIFE QOL
 WHO defined QOL as the individual
WHO defined QOL as the individual’
’s
s
perception of position in life in relation to
perception of position in life in relation to
his goals, expectations, standards and
his goals, expectations, standards and
concerns.
concerns.
 It is to live normal life, to feel happy,
It is to live normal life, to feel happy,
achieve your goals and to be satisfied with
achieve your goals and to be satisfied with
your self and your surroundings.
your self and your surroundings.
 It is the sense of wellbeing.
It is the sense of wellbeing.

37. Why measuring QOL
Why measuring QOL
?
?
 To evaluate the effects of health (and other)
To evaluate the effects of health (and other)
services on citizen
services on citizen’
’s life. The higher the score of
s life. The higher the score of
QOL the better is the promotion services.
QOL the better is the promotion services.
 To classify health hazards according to their
To classify health hazards according to their
effect on QOL (in putting priorities)
effect on QOL (in putting priorities)
 To evaluate the effects of different lines of
To evaluate the effects of different lines of
treatment on patients.
treatment on patients.
 To evaluate the rehabilitation methods used by
To evaluate the rehabilitation methods used by
handicapped.
handicapped.

38. How to assess QOL?
How to assess QOL?
By using questionnaires :
By using questionnaires :
1- physical aspects
1- physical aspects
2- psychological aspects
2- psychological aspects
3- spiritual aspects
3- spiritual aspects
4- social aspects
4- social aspects
5- environmental aspects
5- environmental aspects

39. Global burden of disease
Global burden of disease
Using certain indicators as:
Using certain indicators as:
 QALY= quality adjusted life years
QALY= quality adjusted life years
 DALY=disability adjusted life years
DALY=disability adjusted life years
 YLL= years of life lost
YLL= years of life lost
 YLD=years lost due to disability
YLD=years lost due to disability

40. Thank you
Thank you

41. Health education
Health education
Definition:
Definition:
Is planned opportunities for people to learn
Is planned opportunities for people to learn
about health and make changes in their
about health and make changes in their
behavior
behavior
Steps: to know (knowledge)
Steps: to know (knowledge)
to feel importance to health(attitude)
to feel importance to health(attitude)
to change
to change (practice)
(practice)

42. Era of health education
Era of health education
 Improvement of quality of life
Improvement of quality of life
 Restore state of good health
Restore state of good health
 Make the best of remaining health
Make the best of remaining health
i.e. in health promotion, prevention of
i.e. in health promotion, prevention of
hazards, control of disease and
hazards, control of disease and
complications and in rehabilitation.
complications and in rehabilitation.
i.e. in physical, mental, social health
i.e. in physical, mental, social health
it is life long process.
it is life long process.

43. Health education
Health education
 Source or educator (doctor, nurse, T.V.,
Source or educator (doctor, nurse, T.V.,
book, film)
book, film)
 Message (knowledge, information body)
Message (knowledge, information body)
 Channel (method): face-face or broad cast
Channel (method): face-face or broad cast
 Receiver : the target of the process
Receiver : the target of the process
 Noise (barriers): factors decreasing
Noise (barriers): factors decreasing
response
response

44. Health education
Health education
Health education program:
Health education program:
 What is the message?
What is the message?
 Who will give it? Who is our target?
Who will give it? Who is our target?
 How it will be given?
How it will be given?
 Where?
Where?
 When? How frequent?
When? How frequent?
Evaluation of program.
Evaluation of program.

45. Community participation
Community participation
 People sharing the same culture, experience,
People sharing the same culture, experience,
problems, place they live, language, religion.
problems, place they live, language, religion.
 C. participation is important in:
C. participation is important in:
1- success of health education program
1- success of health education program
2- improving health services
2- improving health services
3- giving power to people to solve health problems
3- giving power to people to solve health problems
and criticize un-needed health services
and criticize un-needed health services or
or
health policy.
health policy.
4- gaining a health responsibility
4- gaining a health responsibility

46. Community participation
Community participation
How?
How?
 Involve representatives in planning and
Involve representatives in planning and
execution team. (in health education)
execution team. (in health education)
 Population needs must be assessed in
Population needs must be assessed in
health planning. They can evaluate also
health planning. They can evaluate also
 Help people to get knowledge, skills,
Help people to get knowledge, skills,
information, fund.
information, fund.
 Enable all population sectors to represent
Enable all population sectors to represent
themselves.
themselves.

47. Behavioral science
Behavioral science
How people think in health & disease
How people think in health & disease
 For health promotion & education
For health promotion & education
 To improve doctor-patient relationship
To improve doctor-patient relationship
 To solve health problems easily.
To solve health problems easily.
People differ in behavior because of
People differ in behavior because of
demographic factors & psychological
demographic factors & psychological
factors
factors

48. Health belief model
Health belief model
Healthy individuals perceive risk, its
Healthy individuals perceive risk, its
severity, that he
severity, that he’
’s susceptible, realize
s susceptible, realize
the benefits of protection from risk,
the benefits of protection from risk,
certain barriers prevent him from
certain barriers prevent him from
taking action. He has motive for
taking action. He has motive for
change. He either decides to act at
change. He either decides to act at
once (with or without trigger) or cancel
once (with or without trigger) or cancel
the whole subject.
the whole subject.

49. Health belief model
Health belief model
Perception of disease
severity
motivation
personal
external
cancel
action relapse
Healthy
behavior

50. Behavior in illness
Behavior in illness
Disease
Do
nothing
Self
treatment
Go to
doctor
treatment
Not
adherent
compliance
cured

51. Factors affecting illness behavior
Factors affecting illness behavior
 Severe, prolonged or frequent symptom.
Severe, prolonged or frequent symptom.
 Unusual symptom
Unusual symptom
 Personal tolerance to symptom
Personal tolerance to symptom
 Culture and knowledge about symptom
Culture and knowledge about symptom
 Stigma of disease
Stigma of disease
 Doctor-patient relationship
Doctor-patient relationship
 Availability of reliable health services
Availability of reliable health services
 Cost of service & ttt. Time waste
Cost of service & ttt. Time waste

52. Communication
Communication
• Definition :it is a dynamic, continuous
and reciprocal sending, receiving and
comprehending messages, feelings &
ideas.
• Relation between communication&health
1. For history taking, counseling
2. For health education
3. Patient satisfaction & adherence to ttt

53. Steps of communication
Steps of communication
• Initiation of simple introduction
• Listening carefully to your client
• Probing to assure your care, observation
of non-verbal expressions
• Giving information: clear, concise,
summarize, in simple language etc..

54. Methods of communication
Methods of communication
• Verbal : spoken or written words
• Non-verbal: any other method except
words e.g.:
1. Body movement, posture, sitting, walking
2. Facial expressions
3. Touch ,shake hands
4. Personal appearance: cloths,hair
5. Voice interference.

55. Barriers to communication
Barriers to communication
• Environmental
• Pathological
• Language
• Personal : SE, values, belief, experience
• Psychological :stress, anger, tiredness