Lalonde Report, 1974

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Lalonde Report, 1974

• Growing emphasis on reducing health risks
  through the promotion of healthy lifestyles
• A New Perspective on the Health of Canadians,
  Lalonde Report .
• Recognized as a milestone document
• International recognition of Canada as a leader
  in the conceptual development of health promotion

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Lalonde Report
Most radical feature of the Lalonde Report
Assertion -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.
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Influence of Lalonde
Enormously influential in shifting the focus
away from an individual biomedical focus to
wider public health . Series of international
health promotion conferences which facilitated
the development and practice of the modern health
promotion movement.
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History of Health Promotion
Earliest records of public health practice,
developed systems for sewage disposal,
distributed surplus grain to feed the poor, and
printed tracts warning against the harmful
effects of consuming too much alcohol. Longevity
of health promotion strategies that have
remained in use to the present day Education
encouraging healthy behaviours at the individual
level, and the development of healthy public
policies at the community level.
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Ottawa Charter
Health promotion is the process of enabling
people to increase control over, and to improve,
their health. 
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Health Promotion

• Health Promotion is a broad process involving
  actions directed at strengthening the skills and
  capabilities of individuals AND actions directed
  towards changing social, environmental and
  economic conditions

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Defining HP
WHO has moved the definition of health promotion
away from prevention of specific diseases or the
detection of risk groups Towards the health and
well-being of whole populations. Instead of
experts and professionals diagnosing problems,
the people themselves define health issues of
relevance to them in their local community. NB!!!
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Defining HP
Health often seen as the responsibility of
individuals alone, Social factors determining
health must be taken into account, Health is
viewed as a collective responsibility of society
Needs to be prioritized by organizations and
government in their decision-making.
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Aims of Health Promotion

• To prevent disease
• To ensure people are well informed and able to
  make healthy choices
• To help people to acquire the skills and
  confidence to take greater control over their
  health
• To change policies and environments in order to
  facilitate healthy choices

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WHO Principles of HP

1. It involves the population as a whole in the
   context of their everyday life, rather than
   focusing on people at risk for specific disease.
2. It is directed towards action on the causes or
   determinants of health to ensure that the total
   environment which is beyond the control of
   individuals is conductive to health.
3. It combines diverse, but complementary methods or
   approaches including communication, education,
   legislation, fiscal measures, organizational
   change, community development and spontaneous
   local activities against health hazards.

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WHO Principles of HP

• It aims particularly at effective public
  participation supporting the principles of
  self-help movements and encouraging people to
  find their own ways of managing the health of
  their community.
• While health promotion is basically an activity
  in the health and social fields not a medical
  service, health professionals particularly in
  primary health care have an important role in
  nurturing and enabling health promotion (WHO
  1977)

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The Heart of HP
According to the WHO, all policy and practice,
whatever its focus, should give full attention
to Equity the equal right to health
care Participation the involvement of people
in the planning and implementation of decisions
involving their health. Intersectoral
collaboration a recognition of the complexity
of factors that affect health and the need for
different agencies to work together.
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Values
Inclusion Empowerment Social Justice Respect Colla
boration Involvement and Participation
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Framework for HP Activities
Preventative health services (Primary, secondary
tertiary
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HP and Professional Practice

• The choice of what we do to tackle a
• health issue depends on how we
• view health
• identify its contributory factors or
• determinants
• 3. define the goals of HP
• 4. view our professional role

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Musculoskeletal Conditions

• The strategies are aimed at
• The whole population
• Those individuals at highest risk
• Those who already have these conditions

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Strategies for the whole population

• Physical activity
• Maintaining an ideal weight
• A balanced diet
• Avoid smoking balanced use of alcohol
• Accident prevention programmes
• Health promotion -work place sport activities
• Creator public and individual awareness
• Good quality information

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Condition Case finding strategy Intervention recommended
Major musculoskeletal injuries Whole population should should be considered at risk Id of risk factors. Create safe communities by removing external risk modify the environment using correct equipment education and training programs obeying rules and regulations maintaining physical fitness avoiding drugs and alcohol
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ACTIONS

• Comprehensive health strategy . At a local and,
  national level.
• Health promotion, prevention, treatment and
  rehabilitation
• Political agenda
• Give priority to research
• Link programmes to prevent musculoskeletal
  problems

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Actions to implement strategies to benefit all

• Raise awareness
• Empower people
• Employment and disability legislation
• Create safe communities
• Create workplace

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Health Professionals

• Ensure all health professionals are aware of the
  need for prevention
• Advocacy role, communicating the burden of
  disease
• Integrated approach between health and social
• Appropriate competency

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The health or Social Care Professional

• Prioritise resources
• Implement guidelines for management
• Provide integrated, co-ordinated, seamless,
  multi-professional, multi-disciplinary care
• Assurance system to ensure the best
• Employer local / national political levels

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How to make it happen

• Champions for change and management
• Needs and priorities for population

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CASE 1

• 59 year old -Indian Lady
• Painful leg Diagnosis cellulitis secondary to
  chronic venous insufficiency.
• Hypertension
• Obesity
• Incontinence
• Tinnitus

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Health Promotion approach

• Develop personal skills (patient, population
  provider)
• Clear information
• H/E material
• Empower her and her family
• Specific intervention stocking elevate leg
• Modify lifestyle exercise
• BMI measure set goals

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Create supportive environment

• Home family Healthy Diet
• Support / additional help
• Community

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Building healthy public policy

• Local National Gov
• SA Hypertension AssocStroke prevention Inst
• Barriers
• CostsAdherence
• Lack of equipment to measure BP
• Strengthening Community Action
• Local hypertension awareness days

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Re orientate Health Services Biomedical model vs

• Obesity - genetic ?
• Gender
• Childhood obesity
• Illness and related conditions
• Prevention
• Discrimination / stigma

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CASE II

• 24 unemployed, single
• Primigravida
• Lower abdominal pain
• / genital tract infection
• Positive HIV test
• Iron deficiency anemia

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• Sexuality prevention
• Very complicated
• Anemia conditional and socio economic
• Nutrition
• Iron supplementation

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• HIV status emotional
• - support
• - policy
• - milk formula?
• - costs
• HEALTH EDUCATION EMPOWERMENT

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CASE III

• 62 obese female
• Hypertensive and diabetic
• Gangrene toe
• Smokers

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EDUCATION

• Stages of change move to action
• Obesity hypertension
• Enabling stop smoking
• Dietary advice
• Exercise
• Policy Vuka move for your health