Health Promotion

Principles and practice in the Australian context

Mary-Louise Fleming, Elizabeth Parker

• Publisher: Routledge
• Year: 2020
• Print ISBN: 9780367718305
• eBook ISBN: 9781000257359
• Edition: 3
• Topic: Medicine
• Subtopic: Teaching Health & Sexuality

'An excellent introduction to the theory and practice of health promotion in a developed country such as Australia' From the foreword by Professor Brian Oldenburg This widely used text offers a comprehensive overview of the field of health promotion. Drawing on current Australian and international research, the authors provide a detailed review of health promotion principles. They demonstrate how these principles fit into the broader public health context, and how they can be integrated into practice in a range of settings, including the workplace, schools, rural communities, Indigenous communities and health care organisations.The authors also include a step-by-step guide to program management from planning to evaluation.This third edition includes new material on the use of evidence in health promotion practice, and on the increasing importance of an ecological perspective. The text has been fully revised with new data and case studies, and planning models have been updated to reflect current practice. Health Promotion is an essential text for students and a valuable resource for health professionals.

PART I
BACKGROUND

Three chapters set the background for health promotion principles and practice.

Chapter 1 traces the history and impact of public health in early European Australia. The different eras of public health and the evolution of health promotion and its development as a legitimate public health endeavour are discussed.

Chapter 2 profiles the social and cultural determinants of health status in Australia, as well as outlining the leading mortality and morbidity profile of Australians. The impact of contemporary Australian policies on health promotion is discussed.

Chapter 3 looks at health promotion within the context of national and international developments of the ‘new’ public health. An ecological public health model and its implications for health promotion are considered, and health promotion initiatives in Australia are highlighted.

1
A social history of public health

• Defining public health
• Health promotion and public health
• Concepts of health and disease
• The origins of public health
• Public health in Australia
• The emergence of contemporary public health

This chapter presents a brief history of public health and identifies the main historical phases that have led to the emergence of what is termed the ‘new public health’. The range of social, economic, political, administrative and lifestyle factors considered to have played a part in influencing developments in public health throughout its history are described and analysed. In addition, some of the significant developments taking place in public health, both within Australia and internationally, are highlighted. Thus, the chapter provides a framework with which to analyse developments leading to the emergence of a contemporary public health perspective.

Measures to improve the health of the public were evident in both Greek and Roman societies. Roman aqueducts, Greek and Roman bathing spas, and the swamp-draining projects are examples of early town planning and public health measures. Some medieval monasteries had proper water supplies, as well as heating and ventilation systems, but most developing European cities had great difficulty in supplying safe water (Terris 1987).

DEFINING PUBLIC HEALTH

Over the centuries, the term ‘public health’ has been defined by various players in the public health field. Historically, the definitions have given us word pictures of the evolution of the field. For example, early definitions were limited essentially to sanitary measures designed to guard against nuisances and health hazards and as protective measures for the community. Decisions about whether a problem fell within the realm of public health were initially based on the criteria of insanitation and, later, communicability. Emphasis on the prevention of disease in the individual appeared later with the emergence of germ theory and the bacteriological and immunological discoveries of the late nineteenth and early twentieth centuries.

The extensions of the definition of public health were created by shifts in values occasioned by particular circumstances. For example, by the end of the nineteenth century the substantial improvements in adult and child mortality were being contrasted with unchanged infant mortality rates. This concern with infant health remained dominant for the whole of the first half of the twentieth century.

The discipline basis of public health developed from an early focus on sanitary science to a latter-day perspective that incorporated medical science (Pickett & Hanlon 1990).

In 1920, C.E.A. Winslow, a professor of public health at Yale University, defined public health as:

. . . the science and art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing service for the early diagnosis and preventive treatment of disease, and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health. (Winslow 1920, p. 3)

Winslow’s broad definition of public health represented an invitation for debate. The endeavours of public health proponents to make all of these activities their own inevitably led to discord between the medical profession and the proponents, as well as disharmony between public health authorities and other institutions. Starr (1982) suggested that much of the history of public health is a record of struggles over the limits of its mandate. These disputes have long antecedents, but the conflict was intensified by an historical convergence between medicine and public health.

Gordon defined public health as ‘the collective measures which a community takes to prevent disease. This means that the agents practising this form of prevention usually are: the federal government; state governments; and local authorities’ (1976, p. 797). Commenting on the future of public health in the late 1970s, Gordon established its boundaries by suggesting that public health had a bright future if it maintained its interest in the whole rather than the separate parts—in other words, if it left the clinical mystique to the clinicians wherever possible. He went on to suggest that the public health world should be training assessors, planners and people who critically contemplate medicine in its social background. Its sphere, according to Gordon, might be seen as including: fact-finding; specific prevention (for example, food and drug regulation, and occupational and environmental health legislation); health education (other than at the level of the individual patient); education of specialists in public health; and overall planning and administration. Meanwhile, Beaglehole et al. define public health as ‘collective action for sustained population-wide health improvement’ (2004, p. 2084).

The account of public health given by Last (1997, p. 6) defines its role in a broad societal context: ‘Public health activities change with changing technology and social values, but the goal remains the same—to reduce the amount of disease, premature death, and disease-produced discomfort and disability in the population’. The Public Health Association of Australia (1997) similarly defines public health as:

... a combination of science, practical skills, and beliefs that is directed to the maintenance and improvement of the health of all people. It is one of the efforts organised by society to protect, promote and restore the people’s health through collective or social actions.

These contemporary definitions of public health have evolved from a social health perspective, one that focuses on the social, economic and environmental determinants of health and disease (Beaglehole et al. 2004). Additionally, they highlight the broad-ranging characteristics of public health practice: those that emphasise collaborative and comprehensive actions and initiatives, embedded in their social context.

One of the most significant contributions to the evolution of public health in more recent times has been the Ottawa Charter for Health Promotion, formulated at an international conference on health promotion held in Ottawa, Canada, in 1986 (Figure 1.1). It has become one of the focal points in the work of the World Health Organization (WHO) in advocating a comprehensive approach to public health and health promotion practice. The charter emphasises the role of healthy public policy, the social and physical aspects of the health environment, community education in health advocacy and action, and the development of individual skills in health advocacy. It reinforces the need to reorient community services towards prevention. The formulation and international adoption of the Ottawa Charter marked the emergence of a framework for action in public health practice that includes five equally essential components:

• consideration of healthy public policy
• creating supportive environments
• educating communities in health advocacy and action
• developing individual skills in health advocacy
• reorienting health services towards implications of preventive strategies.

Figure 1.1: The Ottawa Charter for Health Promotion

Source: World Health Organization (1986a)

The charter has made a significant contribution to the way in which public health is defined and to the range of strategies employed in protection, promotion and restoration of the public’s health. The charter is discussed in greater depth in Chapter 2 (see ‘Principles of health promotion’).

Contemporary definitions of public health extend Gordon’s (1976) and Last’s (1983) notions of collective community measures to prevent disease, by focusing on a multidisciplinary approach that draws on a broad social base.

What has emerged under the title of ‘new public health’ is an approach that brings together environmental change and personal preventive measures with appropriate therapeutic interventions, especially for the elderly and the disabled (Ashton & Seymour 1990, p. 21). The ‘new public health’ is said to go beyond an understanding of human biology to recognise the importance of social aspects of health problems caused by lifestyle. Therefore, many contemporary health problems are seen as being social, rather than solely individual, problems; underlying them are concrete issues of local and national policy. What is needed to address these problems are multisectoral policies that support the promotion of health. The following case study illustrates the utility of wide-ranging policies, strategies and guidelines in addressing one of the factors contributing to health problems.

GOVERNMENT PRIORITIES FOR PUBLIC HEALTH AREAS: SMOKING

Although smoking rates have been declining over the last 30 years in Australia, especially in men, smoking is still the greatest single risk factor for chronic diseases and the single most preventable cause of death (AIHW 2002a). However, there have been improvements: over the past fifteen years, the rates and patterns of smoking have changed, as has tobacco-related morbidity and mortality.

In 1991, the proportion of the Australian population aged fourteen years and over who were daily smokers was 24 per cent (AIHW 2005g); whereas by 2004, this proportion had declined, to 17.4 per cent (2.9 million). In 2004, except for the 14–19-year-old age group, the rate of daily smoking was higher for males than females (AIHW 2004e).

These improvements are, to some extent, attributable to Commonwealth, state and territory legislation prohibiting, restricting or regulating access to or use of tobacco products. Policies, legislation and strategies include:

Demand reduction strategies

Marketing and promotion

• anti-smoking advertisements
• sponsorship prohibited or restricted by legislation
• value-added promotions
• minimum pack size

Education

• health warning labels
• telephone help services
• media campaigns
• school-based programs
• cessation services

Supply reduction strategies

• reducing vending machine numbers in public places
• passive smoking reduction through reducing access to cigarettes
• retailer compliance campaigns

Pricing mechanisms

• Excise (Commonwealth Department of Health 2004).

More recently, public health has aligned itself with the ecological movement and framed public health activities within an ‘ecological public health’ paradigm.

HEALTH PROMOTION AND PUBLIC HEALTH

One of the key concepts in this expanded contemporary vision of public health is health promotion. Health promotion—as a means of achieving ‘Health For All’—is seen as a process of enabling people to increase control over and improve their health. Health itself is regarded as a ‘resource for everyday life, not the objective of living’ (WHO 1986a).

At a general level, health promotion has come to represent a unifying concept for those who recognise the need for change, in the ways and conditions of living, in order to promote health. In this socio-ecological approach the basic resources for health are identified as income, shelter and food. Improvements in health require a secure foundation in these basics, but they also require information on life skills, opportunities for making healthy choices among goods, services and facilities, and favourable social and cultural conditions—a ‘total’ environment that enhances health. Labonte has suggested that health promotion in practice aims to extend the boundaries of medically defined, institutionally controlled forms of ‘programming’. In this new paradigm:

. . . empowerment, or the capacity to define, analyse and act upon problems in one’s life and living conditions, joins treatment and prevention as important health professional and health agency goals. Psychology, political science and social theories join educational, marketing, policy and medical theories in developing program actions. (Labonte 1992a, pp. 6–7)

How has health promotion been defined, specifically? The Ottawa Charter defined it as:

. . . the process of enabling individuals and communities to increase control over the determinants of health and thereby improve their health. It has come to represent a unifying concept for those who recognise the basic need for change in both the ways and conditions of living in order to promote health. Health promotion represents a mediating strategy between people and their environments, combining personal choice with social responsibility for health to create a healthier future. (WHO 1986a)

Health promotion involves techniques which enable:

• public policies and programs to be thoroughly evaluated for their beneficial, neutral and harmful health impacts;
• the reinforcement of the capacity of communities to undertake advantageous action at a local level;
• the developm...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• Figures and tables
• Contributors
• Foreword
• Acknowledgments
• Introduction
• Part I Background
• Part II Planning and managing health promotion programs
• Part III Settings and communities for health promotion
• Glossary
• Bibliography
• Useful websites
• Index