Health Promotion Programs

From Theory to Practice

Carl I. Fertman, Diane D. Allensworth

• Publisher: Jossey-Bass
• Year: 2016
• ISBN:
  9781119163350
• Edition: 2
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

Comprehensive coverage, real-world issues, and a focus on the practical aspects of health promotion

Health Promotion Programs combines theory and practice to deliver a comprehensive introduction to the planning, implementation, and evaluation of health promotion programs. Presenting an overview of best practices from schools, health care organizations, workplaces, and communities, this book offers clear, practical guidance with an emphasis on hands-on learning. This new second edition has been updated to include discussion on today's important issues, including health equity, the Affordable Care Act, big data, E-health, funding, legislation, financing, and more. New coverage includes programs for underserved priority populations at a geographically-diverse variety of sites, and new practice and discussion questions promote engagement on highly-relevant topics.

Public health is a critical aspect of any society, and health promotion programs play an important role. This book provides clear instruction, practical guidance, and multiple avenues to deeper investigation.

• Plan health promotion programs from the basis of health theory
• Gain in-depth insight on new issues and challenges in the field
• Apply what you're learning with hands-on activities
• Access digital learning aids and helpful templates, models, and suggestions

Designed to promote engagement and emphasize action, this book stresses the importance of doing as a vital part of learning—yet each step of the process is directly traceable to health theory, which provides a firm foundation to support a robust health promotion program. Health Promotion Programs is the essential introductory text for practical, real-world understanding.

PART ONE
FOUNDATIONS OF HEALTH PROMOTION PROGRAMS

CHAPTER 1
WHAT ARE HEALTH PROMOTION PROGRAMS?

Carl I. Fertman, Diane D. Allensworth and M. Elaine Auld

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LEARNING OBJECTIVES

• Define health and health promotion, and describe the role of health promotion in fostering good health and quality of life.
• Summarize the key historical developments in health promotion over the past century.
• Describe the impact of Healthy People 2020 and the Patient Protection and Affordable Care Act of 2010 on health promotion.
• Compare and contrast health education and health promotion.
• Describe the nature and advantages of each health promotion program setting and identify health promotion program stakeholders.
• Explain how the evolving U.S. health care system and health technology create opportunities and challenges for health promotion programs.

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Health, Health Promotion, and Health Promotion Programs

The World Health Organization (WHO, 1947) defined health as “a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” While most of us can identify when we are sick or have some infirmity, identifying the characteristics of complete physical, mental, and social well-being is often a bit more difficult. What does complete physical, mental, and social well-being look like? How will we know when or if we arrive at that state? If it is achieved, does it mean that we will not succumb to any disease, from the common cold to cancer?

In 1986, the first International Conference of Health Promotion, held in Ottawa, Canada, issued the Ottawa Charter for Health Promotion, which defined health in a broader perspective: “health has been considered less as an abstract state and more as a means to an end which is expressed in functional terms as a resource which permits people to lead an individually, socially, and economically productive life” (WHO, 1986). Accordingly, health in this view is a resource for everyday life, not the object of living. It is a positive concept emphasizing social and personal resources as well as physical capabilities.

Arnold and Breen (2006) identified the characteristics of health not only as well-being but also as a balanced state, growth, functionality, wholeness, transcendence, and empowerment, and as a resource. Perhaps the view of health as a balanced state between the individual (host), agents (such as bacteria, viruses, and toxins), and the environment is one of the most familiar. Most individuals can readily understand that occasionally the host-agent interaction becomes unbalanced and the host (the individual) no longer is able to ward off the agent (for example, when bacteria overcome a person's natural defenses, making the individual sick).

Clearly, good health doesn't just happen; it's more than just luck. Although being born with good genes and having access to health care are important, they do not provide a guaranteed ticket to wellness. The food we eat, levels of physical activity, exposure to tobacco smoke, social interactions, the environment in which we live, and many other factors ultimately influence our health or lack thereof. The health of individuals and the health of our communities reflect the unique combination of biological, psychological, social, intellectual, and spiritual components as well as the cultural, economic, and political environments in which we live. Exploration of the interaction between individuals and their environment in regard to health has been a hallmark in the progress of nations in promoting and improving the health of individuals and the community at large. This ecological perspective on health emphasizes the interaction between and interdependence of factors within and across levels of a health problem. The ecological perspective highlights people's interaction with their physical and sociocultural environments. McLeroy, Bibeau, Steckler, and Glanz (1988) identified three levels of influence for health-related behaviors and conditions: (1) the intrapersonal or individual level, (2) the interpersonal level, and (3) the population level. The population level encompasses three types of factors: institutional or organizational factors, social capital factors, and public policy factors (Table 1.1).

Table 1.1 Ecological Health Perspective: Levels of Influence

Concept	Definition
Intrapersonal level	Individual characteristics that influence behavior, such as knowledge, attitudes, beliefs, and personality traits
Interpersonal level	Interpersonal processes and primary groups, including family, friends, and peers, that provide social identity, support, and role definition
Population level Institutional factors Social capital factors Public policy factors	Rules, regulations, policies, and informal structures that may constrain or promote recommended behaviors Social networks and norms or standards that is formal or informal among individuals, groups, or organizations Local, state, and federal policies and laws that regulate or support healthy actions and practices for prevention, early detection, control, and management of disease

Source: Adapted from McLeroy, Bibeau, Steckler, and Glanz, 1988.

The ecological health perspective helps to elucidate multiple levels of influence on individuals' behavior and recognizes that individual behavior both shapes and is shaped by the environment. Using the ecological perspective as a point of reference, health promotion is viewed as planned change of health-related lifestyles and life conditions through a variety of individual, interpersonal, and population-level changes.

Health promotion programs provide planned, organized, and structured activities and events over time that focus on helping individuals make informed decisions about their health. In addition, health promotion programs promote policy, environmental, regulatory, organizational, and legislative changes at various levels of government and organizations. These two complementary types of interventions are designed to achieve specific objectives that will improve the health of individuals as well as, potentially, all individuals at a site. Health promotion programs are now designed to take advantage of the pivotal position of their setting within schools, workplaces, health care organizations, or communities to reach children, adults, and families by combining interventions in an integrated, systemic manner.

This focus on planned change in health promotion is applied among individuals in varied settings and at any stage in the natural history of an illness or health problem. Using a framework proposed by Leavell and Clark (1965), health promotion programs can help prevent new cases or incidents of a health problem (for example, preventing falls among the elderly, smoking and drug abuse among...