HEALTH PROMOTION

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HEALTH PROMOTION

• History of health promotion and current policies
• David Marks
• d.marks_at_city.ac.uk

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History of health promotion

• Good health is the bedrock on which social
  progress is built. A nation of healthy people can
  do those things that make life worthwhile, and as
  the level of health increases so does the
  potential for happiness.
• Lalonde, 1974.
• Past can offer an understanding of health
  promotion today

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History of health promotion

• Transition from hunter-gatherer to
  food-raisingimproved survival techniques
• Early civilisations made efforts to promote
  health and prevent disease through sanitation
  and housing
• Collapse of Roman Empire brought a decline in
  public health systems

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History of health promotion

• Middle ages response isolation
• Development of agriculture community action,
  herbal treatments
• Enlightenment period - enquiry into contagion,
  Gin Act, Scurvy linked to diet
• Victorian Times - Poor Law Commission ?
  Preventive Medicine

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The new public health

• Intellectual debates about the role of medicine
• Debates about the future costs of health care
• High-profile failures in public health
• Change in the public perception of health risks
• Source Baggott, 2000

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The new public health - dissenting voices

• Cochranes (1971) call for rigorous evaluation of
  health services
• McKeowns (1976) critique of the contribution of
  modern medicine
• too individualised and disease oriented
• ignored wider social, economic and environmental
  influences on health

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McKeowns (1976) -cont

• Contribution of medicine to decline of disease
  been exaggerated
• Improvements in nutrition and living standards
  key factors
• Major causes of ill health can be prevented.

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McKeowns (1976) Cont

• Attracted support
• Served to focus attention on the wider causes of
  ill health
• Critics
• Szreter (1988) - medical profession key actors
• Sagan (1987) -improvements resulted from higher
  level of resistance to disease

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Towards a health strategy in England

• Preoccupation of funding NHS intensified
• Consideration of measures to prevent illness
  Lewis (1992) - interest in prevention was
  prompted more by a desire to save money than to
  improve medical care
• Little evidence prevention is more effective,
  e.g. smoking cessation (Cairns, 1995)

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Towards a health strategy for England

• Prevention and Health Everybodys Business,
  (DHSS, 1976)
• Key areas for future intervention
• Inequalities in health heart
  disease
• road accidents
  alcoholism
• smoking-related diseases mental health
• drugs
  diet
• venereal disease

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The Health of the Nation (1992) -health strategy
for England

• Previous hostility of Conservative government
  ?Major replaced Thatcher
• Pressure group lobbying e.g. ASH, Alcohol Concern

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The Health of the Nation (1992)

• REJECTED TARGETS
• Immunisation, maternal and child health, oral
  health, food safety
• government argued these were sufficiently well
  developed
• Health of the elderly, asthma, back pain, drug
  misuse
• Further research would be needed to set targets

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The Health of the Nation (1992)

• adding years to life and adding life to years
• cancer
• heart disease
• stroke
• mental illness
• HIV/AIDS and sexual health

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The Health of the Nation (1992) - Example of
Target

• Cancer
• To reduce the death rate from breast cancer in
  the screened population by at least 25 by the
  year 2000 (1990 baseline)
• To reduce the incidence of invasive cervical
  cancer by at least 20 by the year 2000 (1986
  baseline)
• To reduce the death rate for lung cancer in the
  under 75s by at least 30 in men and at least
  15 in women by 2010 (1990 baseline)
• To halt the year on year increase in skin cancer
  by 2005

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The Health of the Nation (1992) -Criticisms

• too NHS focused
• emphasis on disease model
• not multi-agency
• knowledge of its existence was not widespread
• no political leadership
• (sourceUniversities of Leeds and Glamorgan and
  the London School of Hygiene Tropical Medicine,
  1998)

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The Health of the Nation (1992) -Criticisms

• conservative interpretation of health
• completely overlooked
• treating people as whole people and looking at
  them within the context of their community and
  looking at community action, supporting the
  communities to change their own health
• (Source Francome and Marks, 1996)

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The Health of the Nation (1992) -Future
recommendation

• Should address the underlying determinants of
  health and inequalities.
• Use of matrix model has many advantages- it
  enables explicit consideration of both disease
  and population-based models of health
• (sourceUniversities of Leeds and Glamorgan and
  the London School of Hygiene Tropical Medicine,
  1998)

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• HP matrix

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Other Health Promotion Policies

• Health for All by the Year 2000 - WHO - 1977
• Ottawa Charter - WHO - 1986
• Health for All for the 21st Century - WHO -
  1998
• The Community Action Programme on Health
  Promotion, Information, Education and Training
  1996-2000 - EC-1996

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The Community Action Programme on Health
Promotion, Information, Education and Training
1996-2000 - EC-1996

• Uses matrix model
• Shift in blame - support will be given for
  integrated health promotion projects aimed at
  groups which are disadvantaged as a result of
  their vulnerability or social exclusion and
  cultural difference
• Mystifies individual behaviour - alcohol issue

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Saving Lives Our Healthier Nation - 1999

• Action plan to tackle poor health
• Improve the health of everyone
• In particular the health of the worst off
• Reduce young deaths from preventable illnesses

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Saving Lives Our Healthier Nation - 1999

• tougher but attainable targets
• Rejections of old arguments of the past
• recognition of the social, economic and
  environmental factors affecting health
• people can make individual decisions about their
  health
• balance in which people, communities and
  Government work together in partnership

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Individual interventionssource Bennett Murphy
(1999)

• Advantages
• identify the individuals understanding of the
  issue in question
• permit provision of information appropriate to
  knowledge level
• allow issues directly pertinent to the individual
  to be addressed
• resistances to change can be identified
• provide support during change

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Individual interventionssource Bennett Murphy
(1999)

• Examples
• informational
• motivational
• problem solving
• goal setting
• Disadvantages
• small numbers affected - minimal impact on
  population

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Population interventionssource Bennett Murphy
(1999)

• Advantages
• cost -effective
• target more people
• targeted at several levels
• Examples
• setting focused (schools, drop-in)
• community-based

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Population interventionssource Bennett Murphy
(1999)

• Disadvantages
• costly
• complex
• difficult to measure outcomes
• currently still focus on individual change rather
  than structural change

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Government partnerships -e.g. Health Action Zones

• Aim to implement health strategy
• 26 HAZs - areas of deprivation and poor health
• Deliver measurable improvements in public health
• Evidence-based approach
• Link health, regeneration, employment, education,
  social, housing initiatives

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Critiques of health promotion

• Lupton (1997) -HP constrains individual freedom
  and blames the individual for not being healthy
• Radley (1998) -HP assumes a cause and effect
  relationship between experts advice and
  laypersons actions
• Seedhouse (1997) - illusion of shared meaning

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Conclusion

• Health promotion is a discipline that is
  continuously changing
• Health promotion today recognises the several
  levels of intervention
• Scrutiny of health promotion reveals its flaws