Human health, public health and health

1
Human health, public health and healths
promotion. Considerations.
Human health
Health promotion
Public health

• Marcio Ulises Estrada Paneque.
• MD. PhD.

2
Human health.

• WHO 2001 complete physical, mental and social
  well-being state and not only absence of disease
  or ailment.
• This medullary ideas conform the totality in
  health, although there are differences between
  ages, countries, cultures, classes and sorts that
  prevent a homogenous consensus on this
  definition.
• Physical and mental health, and well-being/social
  health, cannot exist independent .
• It belongs to interdependent dimensions.

3
Human health.

• Health is the base for well-being and the
  effective life of an individual or a community.
• Health and disease can exist simultaneously and
  are mutually exclusive only if the health is
  defined restrictively.
• When recognizing health like a state of balance
  of the own, the other and the enviroment, the
  result is that individual and community look for
  to improve it.

4
Human health.

• Health and disease are determined by many factors
  that interact in social, psychological and
  biological form, those that world-wide are
  associate with indicators of poverty and low
  levels of education.
• Association of poverty and bad health happens in
  all societies, independent of its levels of
  development.
• Factors like the insecurity, violence and changes
  of articles of incorporation and styles of risk
  life, increase the vulnerability and condition
  the propensity to the development of diseases.

5
Public health.

• Public health is science and art to promote
  health, to prevent diseases and to prolong the
  life through organized efforts of the society.
• The gains in health have been obtained as a
  result of improvements in the economic income,
  education, water provision, nutrition, hygiene,
  house, and health services.
• It are also result of new knowledge on the
  causes, prevention and treatment of the diseases.

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Public health challenges.

• Demographic and epidemiologic changes,
  environment deterioration, modern life
  conditions in the great cities, accidents and
  chronic diseases constitute sanitary challenges
  in this century.
• This scene requires to implement strategies of
  public health that prevent the diseases
  appearance and promote the total development of
  the health.
• These challenges exist due to the priority of
  diseases treatment services by on promotion
  programs and primary prevention of diseases.

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Advances in the Public Health

• Implementation of policies that make possible
  more accessible intervention programs.
• Individual combination of structural changes and
  actions.
• 21st century What causes that the people are
  healthful?
• Health genesis versus pathogenesis.

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Stigmata for the global public health.

• Every six seconds, a boy dies of hunger and is
  1000 million hungry people in the planet.
• Inequalities and lack of cover in the health.
• Increasing prices and the climatic change events
  exacerbate this situation.
• Causes marginalization, poverty, lack of earth
  and employment and unjust international economic
  order.

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Prevention of diseases and health promotion (HP).

• Prevention of diseases and health promotion are
  different to each other, but their objectives are
  superposed.
• Both interventions are complemented, although but
  promotion and reach the public to whom it goes
  directed are much more ample

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Prevention of diseases.

• Concept of prevention in health derives from the
  classic paradigm of public health that
  distinguishes three levels of prevention
• Primary Oriented to prevent diseases appearance
  in susceptible populations. It uses as much
  interventions of health promotion like specific
  protection.
• Secondary Its objective is to shorten the
  disease duration once it has appeared, to reduce
  the contagion probability, and to limit sequels,
  through early diagnosis and opportune treatment.

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Prevention of diseases.

• Tertiary Directed to people with irreversible
  diseases to which it is not had effective
  treatments.
• It tries to preserve the functions, to diminish
  incapacity, to diminish underlying disease
  complications and to harness rehabilitation.

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Preventive interventions.

• Preventive interventions must take into account
  the diverse diseases causal factors, considering
  its biological, psychological and sociocultural
  components.
• Actions must focus, with preference, at the
  level of public health instead of the individual
  level.
• If is difference in the disease incidence or
  prevalence in comparable population groups,
  exists the possibility of realizing primary
  prevention.

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Preventive interventions.

• Preventive actions have inevitable repercussions
  in numerous health problems, besides specific
  condition to which they are directed.
• Design of preventive interventions must be based
  on an ample conceptual model with impacts in
  diverse problems.
• It must consider human conduct like a crucial
  factor. So that the prevention will be effective,
  it requires of individuals changes in attitudes
  and conducts at the same time as changes in the
  systems.

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Health and disease.

• Individual health is affected by individual
  factors, social interaction, cultural structures
  and values society resources
• Economic levels have implications in the familiar
  health and mental health, social and conduct
  interact problems and intensify those
  implications. Substances abuse, mistreat and
  violence are consequences and factors that deepen
  those problems.
• Health and disease has multi-factor origin and
  can exist of sequential and continuous form.

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Differences in health concepts.

• Nonprofessional people consider to be healthful
  when they do not have disease or they compare
  health with vitality and autonomy.
• Majors adults define as an inner force and the
  capacity to confront lifes challenges.
• Young people think about health like good
  physical training conditions, energy and
  strength.
• Those that lives in prosperity think health about
  the context to enjoy the life and those of less
  resources think it like having the basic needs to
  live.

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Health promotion (HP).

• Health promotion, a still emergent field of
  action, frequently is defined of indirect form,
  examining primarily the health idea, when that
  term is vague in itself, because it can talk
  about as much to presentsstates show like
  disease or incapacity absentees.
• Health can talk about a sufficiency state and
  aptitude, or usable individual resources when it
  are needed.
• Different conceptions exist on health and its
  promotion, according to the diverse cultures and
  experiences.

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Textual definitions on PH.

• Process that confer to the population means to
  assure a greater control on its own health and
  get it better (Ottawa Letter 1986) PAHO/OMS,
  1996).
• Strategy directed to the profit of an integral
  advance in life quality, every time in greater
  degree, like the sum of population actions,
  health services, sanitary authorities and other
  social and productive sectors, directed to the
  development of better conditions of individual
  and collective health ". (PAHO/WHO, 1996).

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Influential factors in HP

• By his repercussion in theoretical and
  pragmatic aspects of the HP, this emphasize the
  following
• Little precision in the concept of health and the
  responsibility that it infers.
• Multicausalty of health and disease.
• Little clarity in people in charge to develop it
  (sectors, communities, family and individual).
• Insufficient evidence on its effectiveness.

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Promotion and health theories.

• Unified theories of health, like the WHO one,
  include individual and environmental factors.
• It implies that health promotion must focus so
  much to the individual as to environment, and
  surpass the medicine classic model centered in
  doctor and patient, or the supplier and the user.

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Promotion and health prevention.

• Promotion of health is action and law to
  approach, to modify the health determinants that
  are modifiable.
• Promotion and prevention are activities that are
  related and superposed.
• First one takes care of determinants and the
  second is concentrated in the diseases causes.

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Promotion and health determinants.

• Determinants are factors that improve or threaten
  the individual or community health state
• It can be
• of individual option (styles and habits),
• related to social, economic or environmental
  characteristics outside the individual control
  (class, sort, education and house)
• at communitarian level (social participation,
  demand and/or labor availability and quality of
  air and water)

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Interventions in health promotion

• Interventions of any level (local/national), can
  improve health.
• Intervention strategies were defined in Ottawa
  letter (WHO 1986) with five strategies of action
  
• To conform healthful public policies
• To fortify communitarian action
• To develop personal abilities
• Creation and protection of healthful atmosphere
• To reorient health services

23
Practice of health promotion.

• Diverse surroundings of health promotion have
  common characteristics, based on the
  collaboration - action and social participation,
  and the functions of planning, implementation and
  evaluation of the programs.
• All promotion models agree in which people
  potential is due to develop, to control and to
  protect its own health and to collaborate with
  others one

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Health promotion models.

• These models include
• Study of needs, resources, priorities,
  communitarian structure and participation
• To make altogether instead of do for
• Plan of action in consensus, management of
  resources, monitoring of action and changes
• Emphasis in the evaluation and dissemination of
  best practices to improve the quality.

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Evidence on health promotion.

• From 1998, WHO promoted use approaches based on
  the evidence in the promotion actions.
• Generation of evidences on effectiveness in
  health promotion is a challenge, since it is a
  social action and it is difficult to control it.
• In order to measure its effectiveness, the
  consensus is based on the methodological
  triangulation, that allows to interpret
  evidences convergence of different classes, in
  different places and generated by different
  investigators.

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Principle of prudence.

• It recognizes that all evidence can have
  deficiencies, that never is possible to arrive to
  say as much as to act with absolute certainty,
  but that sufficient certainty on quality
  evidences allows to make recommendations for the
  action.
• Evidence on effectiveness of health promotion
  derives from the investigation based on the
  community.
• Its not possible to be trusted the quantitative
  traditional measures totally. When including
  qualitative methods, will exist a better
  understanding of what it works and what no.

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Force of the evidence in HP.

• In health promotion two medullary questions with
  respect to the evidence exist
• - The force that has and its implications for the
  investigation, the practice
• - The design of policies.
• Evidence force is determined by the design of
  interventions and methodological aspects like
  validity and control of slants (falsification-pred
  iction and repeatability). Evidence can be of
  four types.

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Types of evidence and HP.

• A We knows what works, how it works and its
  repetition is universal.
• B We knows that it works, how it works and its
  repetition is limited.
• C Is known that it works, the repetition is
  universal, but is not known how it works.
• D Is known that it works, is not known how and
  repetition is limited.

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Investigation in health promotion.

• It works in an atmosphere where numerous factors
  interact economic, social, cultural and
  political.
• This complexity very often not allows to obtain
  the sufficient results to obtain evidences of
  type A. HP strives in obtaining evidences of the
  B type, which has implications for the practice.
• Effectiveness of an intervention for HP, not
  always is guaranteed beforehand. Therefore
  evaluation investigation must be combined with
  the practice of HP.

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Social capital and HP.

• Concept of social capital has been assumed to
  reconstruct individual action in the
  investigation on SHD means, it is more than
  qualification to improve the individual
  productivity (capital human) and then it
  projects itself to social organization (networks
  and norms) that facilitates coordination and
  cooperation for mutual benefit.
• Social capital is not a perception or individual
  resource, is for collective action and promotes
  growth, social and economic development. Relation
  between social capital, health and health
  promotion, is actually subjects of investigation
  and debates.

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Social capital, risk and HP.

• Population health measures and risk factors are
  considered like a sum of individual
  characteristics in a population. Environmental
  association of one or more factors and individual
  health.
• Social capital approach them like interaction
  between environmental and social factors, and tie
  groups of individuals (perspective of networks),
  it explains the collective results variety,
  beyond the explained thing by the individual
  results of health. The social networks promote
  social cohesion, informal attention, protection
  in crisis and better education for health

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Conceptual frame in HP action.

• It must be concentrated in
• Social and economic determinants of health
  (social inclusion, absence of inequities
  discrimination and economic participation).
• To include all different methodologies from HP
  that work concerning population.
• To involve to all and different sectors becoming
  made responsible with HP.

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Conceptual frame in HP action.

• Health promotion practice must
• Focus in the promotion of well-being instead of
  the disease.
• To consider the population like a whole,
  including those that present risk conditions.
• To orient itself towards action on health
  determinants such as income and house, rather on
  risk conditions and factors,

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Conceptual frame in HP action.

• To include an ample rank of strategies, such as
  communication, education, organizational change,
  communitarian development and local activities.
• To recognize and reinforce population
  competitions.
• To include sanitary and social aspects at the
  same time as medical services.

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Health promotion components.

• Social communication.
• Social learning.
• Intersectoral coordination.
• Social participation.
• Healthful surroundings.
• Promotion of effective health, produces changes
  in health determinants.

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Social communication and HP.

• Mass media are a vehicle to canalize educative
  information, motivation and contents. In health
  promotion and prevention it serve to harness
  individual and collective conducts.
• Programs arise from determined population
  evaluation of needs, susceptible to be boarded by
  means of these strategies.
• It requires of problem knowledge and scientific
  evidence on the promotional or preventive
  interventions of greater effectiveness.

37
Social learning and HP.

• Is a interactive, reflective and critical process
  in which participant people develop values,
  knowledge and abilities, through its active and
  experiential participation, to reinforce
  protective factors (promotion) and to modify risk
  factors (prevention).
• Results are obtained favoring expression of
  creative capacity for construction of a
  collective knowledge, where contribution and
  experience of each participant contribute to the
  group learning.

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Intersectoral coordination and HP.

• Intersectoriality is the agreement of political
  and technical wills of diverse social sectors to
  implement integral proposals destined to improve
  the population health situation.
• It complements approaches of different scopes,
  mobilizes resources and takes part jointly or
  coordinated around health. Thus it is avoided to
  duplicate to efforts and resources.
• Intersectoriality occurs in all society
  organizational scopes, as much at national level
  as regional and local, considering public and
  private institutions.

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Social participation and HP.

• It is a real and effective capacity of people,
  families or groups to indirectly influence or
  make decisions on the health subjects that
  affects them directly.
• It is a social process where all the actors
  identify needs or health problems and are united
  in an alliance to design and to put in practice
  solutions.
• Social participation in health acts of shared in
  common form, evaluates and exerts a social
  control on health system.

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Healthful surroundings.

• People and communities environments formed not
  only by a physical dimension, but talk about
  social, economic, cultural and political aspects.
  
• It constitute communities life conditions and are
  a great extent determining of people health.
• Labor districts, communities, towns, schools and
  other centers are influential surroundings to
  become healthful.

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Interventions in HP.

• Directed to
• General population.
• Vulnerable pre-school and babies.
• Schools children.
• Adults and majors adults in risk.
• Individuals and groups with previous health
  problems.
• Special groups.

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Challenges in HP.

• Health promotion is reduced and is confused with
  the health education
• Family doctor roll in a the new vision of HP.
• Improvement of formation and major stimulation by
  health promotion activities.
• Major participation of directive, managers of all
  health centers and institutions.
• Improve infrastructure for health promotion
  development in familiar medicine.

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Conclusions.

• Medicine and public health advance together with
  its styles of action.
• Satisfaction, well-being and quality of life
  improvement of a person (ill, in risk or
  apparently healthful) and their surroundings are
  fruit of a joint work of health professionals and
  society.
• If yesterday we dedicated ourselves to patient
  and risk, today is necessary to see people in his
  integrity, with a human and holistic base,
  harnessing his capacities, so that it can face
  the challenges of environment.

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Conclusions...

• If we yesterday saw the person in a clinical
  frame today we must see it beyond its
  surroundings in the scope that lives, studies or
  work, with a holistic and integrating approach.
• Enable and to do participates person, the
  community as far as health self-management
  (Health promotion) this it is defied that public
  health professionals should face.