Health Promotion in the 21st Century

New approaches to achieving health for all

Mary-Louise Fleming, Louise Baldwin, Mary-Louise Fleming, Louise Baldwin

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000257373
• Edition: 1
• Topic: Medicine
• Subtopic: General Health

How should we invest precious health resources? At a time when chronic illness is increasing, inequality persists and climate change is starting to impact our health, how can health promotion improve health outcomes across the whole population? Health Promotion in the 21st Century offers a systematic introduction to the principles of health promotion today, and effective planning, implementation and evaluation. The authors review the global, regional and local issues that affect health in Australia, and show how social, economic, political and educational elements in society contribute to population health and wellbeing.Throughout, the authors emphasise that health promotion needs multiple solutions, and that health professionals should seek out strategic opportunities and partnerships. They consider the issues facing vulnerable groups - such as Aboriginal and Torres Strait Islander people, those with mental health issues, and the aged - and suggest a variety of innovative tools for working with particular populations. They also focus on strategies to ensure programs remain vibrant and sustainable in the longer term.With case studies and activities in each chapter, Health Promotion in the 21st Century is an essential resource for anyone seeking to build a career in health promotion.

1
The importance of health promotion principles and practices

Mary-Louise Fleming

Learning objectives

1. Describe examples of the range of broad arid diverse futures for health promotion.
2. Critique the role of technology in the practice of health promotion.
3. Explore globalisation and resource constraints and examine their impact on workforce development.
4. Consider the health promotion workforce and the re-emergence of health promotion and prevention in a rapidly changing world.
5. Discuss the economics of prevention.

APPLYING HEALTH PROMOTION PRINCIPLES AND PRACTICES

The application of health promotion principles and practices is a very important part of the advancement of population health for a number of reasons. First, in addition to enabling people to live productive lives, promoting health and wellbeing helps to keep people out of the healthcare system for longer. Where it is necessary to be admitted to hospital, health promotion can often also assist a return to a good quality of life after treatment. Second, while the focus of health promotion is the entire lifespan, specifically targeting the health of young people supports the foundations of good health practices. Third, both socially and economically, it is important to consider the social benefits of good health as well as the economic benefits to society of community wellbeing. Fourth, a focus on health and wellbeing helps to enhance mental health. Fifth, joined-up multi-level and multi-dimensional programs, from policy and legislation and whole-of-population strategies to self-help and more intensive interventional support, need to be implemented so we have the best opportunities possible to reach the entire population in different ways at different times. Finally, changing technologies and advances in access to and use of multiple technologies can be used as positive tools for the promotion of health.

Furthermore, when applied to the promotion of health, the important principles of access and equity ensure that all sectors of society can access a continuum of care within the health-care system. Aboriginal and Torres Strait Islander health and wellbeing are clearly influenced by factors other than the individual's ability to make changes, meaning that many factors influence health and wellbeing beyond the provision of health care.

Recent examples of such influences are as diverse as the Royal Commission into Institutional Responses to Child Sexual Abuse (2013), the Royal Commission into Misconduct in the Banking, Superannuation and Financial Services Industry (2017) and the Royal Commission into Aged Care Quality and Safety (2018). Some of these examples have a clear link to health care, while others may appear more distant, yet all the findings of these Royal Commissions have an impact on health and wellbeing. Health promotion must be multisectoral because health and wellbeing are influenced and impacted by many factors outside health, including level of education, housing, meaningful employment and access to transport.

In this textbook, we show how complex the dimensions and determinants of health can be, and how many sectors play an important role in sustaining health and wellbeing. We also explain why factors outside of health contribute substantially to ensuring and promoting ongoing health and wellbeing.

THE CHANGING CONTEXT

The promotion of health involves a range of policy and legislative approaches that work towards engaging communities and populations in the pursuit of wellbeing (Jancey et al. 2016). These efforts need to be cognisant of generational changes in the population and must be flexible and adaptive in their application.

This fact is exemplified by the Ninth Global Conference on Health Promotion in Shanghai (2016) and the subsequent release of the Shanghai Declaration on Promoting Health. The World Health Organization's (WHO) 2030 Agenda for Sustainable Development (WHO 2016) provides evidence of the resilience and capacity of health promotion to be applicable in a more complex world. Further, reference to the Sustainable Development Goals clearly links to strategies that trace their heritage to the Ottawa Charter for Health Promotion (WHO 1986). The Shanghai meeting was important because, for the first time, there was consideration of the role and contribution of the World Health Organization to the achievement of the United Nations Sustainable Development Goals, beyond Goal 3, the health-specific goal (Kickbusch and Nutbeam 2016).

It is also important to ensure that the discourse about health issues and the politics of health focus on the social determinants of health. While there is a clear discourse about overweight and obesity in the context of implications for the health and wellbeing of individuals and the population more generally, a discourse also exists about obesity and the politics of 'fatness'. In this latter discourse, Monaghan, Colls and Evans (2013:249) disagree with contemporary research and policy focusing on weight, size and fatness as a proxy for health and assumptions that diet and/or physical activity are the clear explanations for obesity. Recently, Young, Hinnant and Leshner (2016) suggested that there should be a greater focus on the social determinants of health in contemporary anti-obesity campaigns that often over-emphasise the role of individual behaviour in obesity at the expense of other factors.

It is also worth reminding ourselves that 'technology' in its multiple forms has emerged as a challenging part of our future world. Younger generations are technologically savvy, use multiple types of technology—some of which are clearly disrupters of current ways of doing things—nd are open to many more new and innovative technologies. That is why we cannot rest on past health promotion successes: each new generation will need to see the relevance of the promotion of health and wellbeing to them as we embrace new and different ways of using technology in the pursuit of wellbeing. We must always remember that access and equity are fundamental principles of the social determinants of health and need to be placed front and centre of all policy and practice (Marmot 2018). As Baker and colleagues (2018) suggest, better strategies for influencing decision-makers and moving health equity as a priority in the future will require advocates to appreciate the factors that influence government agenda-setting.

DEFINING AND DESCRIBING HEALTH PROMOTION

The Ottawa Charter for Health Promotion (1986) emphasised healthy public policy, the social and physical aspects of the health environment, community education for health advocacy and action, and the development of personal skills as the component parts of health promotion. These components are as applicable today as they were some 30 years ago (Tilford 2016; Tilford 2017). As we traverse these issues in this book, we will consider and critique these areas of focus. Clearly it is worth considering how much the definition of health promotion has changed or been modified over the last 30 years (Nutbeam 2018; Smith, Crawford and Signal 2016).

This book is divided into this introductory chapter, which outlines the overall content of the book, and three major sections:Part 1—romoting health; Part 2——ealth promotion in action; andPart 3——ealth promotion skills in practice. A final chapter draws together the major points made in the book and considers the evolution of health promotion efforts in the 21st century.

PART 1: PROMOTING HEALTH

This part introduces the evolving definitions of health, health promotion, public health and primary health care. Chapter 2 provides a broad grounding in health promotion theory and practice, both internationally and within Australia. It includes an introduction to the future of health promotion, social and demographic influences, definitions of health education, health promotion and public health, and the relationship between such definitions. It concludes by looking at the challenges health promotion will face in the future. The economics of prevention, as discussed in Chapter 3, has become a centrally important conversation about the value or worth of health promotion practice. For decades, advocates of health promotion practice have argued that promotion of health keeps people out of hospital and healthy for longer, thus reducing the load on an already over-burdened hospital system. Others have advocated strongly for measuring the economic benefits of prevention as a strong argument for funding for health promotion practice.

Chapter 4 focuses on complexity and risk. Essentially, this chapter is concerned with epidemiology. It examines a range of health issues, discusses the impact of multiple risk factors and broadly considers health determinants and other factors impacting on health. It uses examples to articulate complex health issues—often referred to as 'wicked problems' because there are multiple causative factors that require complex solutions. Complexity is a central theme running through this chapter—for example, it explores how complexity influences risk; how we handle complexity; how we intervene at a variety of levels; and why health promotion needs multiple solutions and strategic opportunities.

Chapter 5 concludes this part by addressing issues of Indigenous health and wellbeing. Issues of access and equity for Aboriginal and Torres Strait Islander Australians are considered and the chapter explores why particular health promotion programs have been successful. The chapter includes examples of health promotion programs designed by Indigenous health workers for Indigenous people. It also examines the range of factors that enhance health and wellbeing for Indigenous people and looks at the factors that continue to impact the health of Aboriginal and Torres Strait Islander people.

PART 2: HEALTH PROMOTION IN ACTION

Settings and other approaches for health promotion are the focus ofChapter 6. We examine the frameworks that guide a settings approach and also consider how other approaches can intersect with settings to provide greater depth and complexity of health promotion activity. The chapter considers what contemporary frameworks for health promotion might look like. Does a settings approach address health issues as the best source of focus? How does a traditional approach to a setting meet the needs of, for example, a workforce that is increasingly casualised, online and/or self-employed?

Chapter 7 focuses on social and behaviour change in theory and practice in health promotion. We help develop an understanding of common behaviour change theories and look at how they can be applied to current health challenges. We describe the key constructs of at least two theories commonly used in public health interventions and identify important future considerations for health-related behaviour change.

Chapter 8 examines the role of governments, organisations and communities and considers the potential for both synergy and tension between these elements. The role of governments at all levels in health promotion and wellbeing suggests some degree of working together, but also a fair degree of individual activity. For example, how a state health department organises its health promotion policy, strategies and programs will often difter from what occurs at a regional or council level. We ask questions about how they do and could work together, and find out what hinders synergy.

Chapter 9 examines the role of policy, legislation and environmental change in health promotion. We present evidence of best practice to enhance positive wellbeing rather than relying solely or predominantly on the individual to change their behaviour. The critique of this perspective is often presented as being about civil liberties. Is this a 'nanny state'? Are we blaming the victim? We consider the middle ground, where individual responsibility combines with legislative and environmental changes to make healthy choices easier for the population. We also consider how politicians respond when they are faced with economic issues as well as examining the impact of health, social and environmental issues.

PART 3: HEALTH PROMOTION SKILLS IN PRACTICE

Using evidence to inform practice, we consider what works in the planning, managing and implementation of health promotion.Chapter 10 examines planning theories: what they are, their areas of focus and how they are used in practice. Planning is not a linear process, as evidenced by the examples presented and the considerations required when putting theory into practice.

Chapter 11 considers new ways of thinking about evaluation as a combination of both practical and theoretical approaches. Populations and sub-populations are tired of being evaluated, but how else do we know whether programs work? What evidence do we need and for whom? Do we need to examine and evaluate different levels of change and how is evaluation funded? Are there sufficient funds or is it not entirely about the money? These important questions are considered in this chapter.

Chapter 12 addresses wha...