Chapter 7 – Health Promotion

Lecturer PowerPoint
Lecturer Lesson Plan
Additional Case Study
3 Papers
3 Websites
3 Media Articles
Learning Tasks Discussion
Issues you may have considered in relation to the Learning Tasks in the book…

Learning Task 1: What do you think health promotion is?

All the activities can be classified as health promotion, although they can be sub-classified on the basis of the methods and approaches that are used. For some people, their ideas about the scope of health promotion can be quite narrow, mainly focussing on health education or linking only to health services and healthcare professionals. However, we have seen in the earlier chapters that factors that determine our health are not centred on healthcare or healthcare professionals’ work, and therefore a broader understanding of the scope of health promotion should be considered if the wider environmental socio-political determinants can be shaped for health improvement. If you had a narrow characterization of the scope of health promotion, it could be that you are conceptualizing the word ‘health’ in biomedical ways and not drawing on principles in the social model of health. If you thought that many of the activities were health promotion, then you are likely to be thinking about health in a holistic manner and have a good understanding of the social model of health and that health can be determined outside of health-service provision

If you had limited resources, which three would you invest in? What shaped your decision-making? Several things may have influenced your choices and may have included the following factors which are linked to key principles of health-promotion practice discussed towards the end of this chapter:
 The most effective generating the biggest health gain (evidence-based practice)
 Those that are ethical
 Those that may be cheaper
 Those that may be easier to set up and implement

Learning Task 2: Applying Beattie’s model of health promotion

Below are examples of the activities that relate the 4 different approaches that are conceptualized with Beattie’s model.

Community development
 Local people protesting about the closure of a specialist centre for cancer
 Community safety schemes, e.g. neighbourhood watch
 Food produced in local allotments used in a café staffed by community members
Legislative action and policy
 Setting a minimum wage
 Local authority maintaining local parks and recreation services
 Regulation by local council to reduce the number of fast-food outlets
 Higher taxation for individuals earning over £100 000
Health Persuasion
 Campaign about drinking and driving
 Soap opera storylines about domestic violence
 Traffic light labels on food
Personal counselling
 Practice nurses giving information about how to manage weight

Learning Task 3: Behaviour-change campaigns

These campaigns were produced as public information films and are linked to classic health education via mass media approaches. All of the campaigns have simple messages. Some are linked to giving information in order that people can make informed choices about their lifestyle while others are attempting to consider the stigma of sensitive health issues or change our perceptions and attitudes about health-related behaviour.

Emotions can be important in eliciting a response that can then trigger antecedents of behaviour change. If you empathize with the imagery or scenario, you are more likely to process the central message. A recent study by Gerend and Maner (2011) examined how the emotional state of recipients of health-education material regarding eating fruit and vegetables affected the amount of fruit and vegetables eaten, and concluded that the messages were received differently depending on the emotional state of the recipients.

There is great debate about whether public health information films should use shock, fear and graphic imagery in order to facilitate a change in people’s behaviour. What do you think about this and how does it relate to principles of research ethics? There is an article in the resources section below that develops theoretical ideas about the use of fear-based public health campaigns.

There is very little evidence that public information mass media campaigns can change behaviour directly. Nevertheless, they can raise important issues in the public consciousness and can be linked to other approaches such as community development or legislation to facilitate change.

Learning Task 4: Ethics in health promotion

Autonomy is defined as “Respect for the rights of individuals and their rights to govern their own lives” (Naidoo and Wills, 2000 p. 91). To some degree, screening can comprise the rights of the individual to govern their own life unless they make an explicit decision to take part in the screening process. In order for women to make a decision to be screened or not, they must have access to accurate information. For example, are women told that the cause of cervical cancer is a sexually transmitted virus, Human Papilloma Virus (HPV), or is this information withheld in the interest of women attending screening? Are women told about the probability of obtaining a false screening result and what anxiety this may raise? The quality of the screening test is defined by the sensitivity (ability to detect true positives) and specificity (ability to detect true negatives) of the Pap screening. The sensitivity of the Pap smear is relatively low and the specificity very high. This information may be important in both the decision-making processes to take part in the Pap smear test and the anxiety when obtaining a smear result before undertaking a confirmatory test. Only by giving complete and accurate information to women in order that they can make informed decisions can their right to consent be upheld even if they choose not to take part in screening.

Beneficence : At its heart, screening is considered to do ‘good’. Screening is undertaken in order to identify either disease or pre-disease before symptoms are experienced. The intended benefits of cervical screening using Pap smears are to identify changes to cellular morphology before a tumour has formed. Laser treatment is undertaken to destroy abnormal cells thereby preventing occurrence of the disease in the future. It is possible that cervical cancer may be detected and early treatment of the tumour with surgery or radiotherapy many improve survival and cure rates.

Non-maleficence: The process of having a Pap smear can be unconformable, unpleasant, at times painful and for some may raise gender issues if men undertake the smear test. As we have seen in the section on autonomy, anxiety may be raised in women at several stages of the screening process, including while waiting for a screening result, after receiving a screening test result and during the process of a confirmatory test being done. To some degree, these potential harms are balanced against the potential benefits and should be considered by women as part of the informed consent decision-making process, prior to a smear test taking place.

Justice: People should be treated equally and fairly. In theory, screening itself does not compromise fairness or equally unless the resources involved in screening, such a clinics or healthcare staff, are unequally distributed, preventing access and further treatment and care. It is possible that, in some societies or regional areas, higher-social-class women have access to better information, high-quality screening resources, and may feel less stigma associated with cervical screening.

In summary, cervical screening can be ethical if women have access to high-quality, comprehensible material in order to make an informed decision. However, processes can be improved; for example, screening for HPV has greater sensitivity and specificity, and is less traumatic, although it can be more expensive.

Multiple Choice Quiz

1. The Health Promotion movement in the UK arose from:
a. the Central Council for Health Education
b. vaccination programmes
c. the formation of the National Health Service
d. the first public health manifesto

ANSWER

The correct answer is a.

2. Which of the following underpins contemporary health promotion practice?
a. The biomedical approach of health
b. The pathogenic approach to health
c. The social model of health
d. The reductionist approach to health

ANSWER

The correct answer is c.

3. Which one of the following is NOT considered to be a health promotion approach for cervical cancer?
a. Screening for cervical cancer
b. Radiotherapy for treatment of cervical cancer
c. Encouraging sexual partners to negotiate safer sex
d. Peer-based sexual and relationship education (SRE)

ANSWER

The correct answer is b.

4. Healthy public policy is defined as…?
a. Policies that are formed by the Department of Health
b. Policies that protect us all
c. Policies that enable is to be reduce ill-health
d. Consideration of health in all areas of policy

ANSWER

The correct answer is d.

5. Which concept is the upstream approach in health promotion most closely related to?
a. Primordial prevention
b. Secondary prevention
c. Tertiary prevention
d. The biomedical model

ANSWER

The correct answer is a.

6. Which of the following is NOT an ethical principle that relates to health promotion practice?
a. Autonomy
b. Salutogenesis
c. Non-maleficence
d. Beneficence

ANSWER

The correct answer is b.

7. Why is non-victim-blaming important in health promotion practice?
a. No-one likes to be blamed for their behaviour
b. It is part of the biomedical model
c. It acknowledges that health behaviour is shaped by external factors such as living conditions and life experience
d. It is not autonomous

ANSWER

The correct answer is c.

8. What is equity in health terms?

a. The equal distribution of health status
b. Health status is based on what people deserve
c. Health status is based on genetic predisposition
d. The fair distribution of health status

ANSWER

The correct answer is d.

9. Which one approach is not evident in Beattie’s model of health promotion?
a. Health-persuasion approaches
b. Community Development approaches
c. Biomedical approaches
d. Legislative approaches

ANSWER

The correct answer is c.

10. Which of the following is not a critique of health-promotion practice?
a. There is little evidence that health promotion is effective in producing health improvement
b. Health promotion tries to regulate people’s lives
c. Health promotion is underpinned by several academic disciplines
d. Health promotion is everybody’s business and no-one’s responsibility

ANSWER

The correct answer is c.

Additional Case Study: Problem Solving for Better Health

An example of a school-based health-promotion programme which utilized a holistic and multi-approach strategy utilizing the principles of participation was ‘Problem Solving for Better Health’ in Rio de Janeiro (Becker et al., 2005). One hundred and twenty schools were involved in the project which aimed to provide support and resources for teachers to analyse their specific school health issues. The project took to form three phases:
i) Preparation, where school staff defined their school’s health issue/s which would be addressed by the project.
ii) Planning seminars, in which health-promotion facilitators worked with school staff to exchange ideas and analyse the issue/s in order to stimulate action planning to address the issues.
iii) Follow up involved visits by facilitators to further build capacity, monitor progress and disseminate actions through newsletters

Some of the health issues addressed were violence in schools, improvement of learning and self-esteem, and environmental problems. Through its methodology, ‘Problem Solving for Better Health’ promoted a stronger sense of ownership and a more creative socially based action to addressing self-defined health issues.

3 Papers

Gagnon, M., Jacob, J.D. and Holmes, D. (2010) Governing through (in)security: a critical analysis of a fear-based public health campaign. Critical Public Health, 20(2): 245-256. LINK
A contemporary theoretical discussion about issues of power and social control implicit in sexual health public-health campaigns.

Calman, K. (2009) Beyond the ‘nanny state’: Stewardship and public health. Public Health, 123: e6–e10. LINK
An examination of the role of the state versus the individual in health-promotion action, drawing on ideological positions and principles of ethics. Calman argues for the model of stewardship in taking this agenda forward.

Parkes, M.W. and Horwitz. P. (2009) Water, ecology and health: ecosystems as settings for promoting health and sustainability. Health Promotion International, 24(1): 94-102. LINK
Given the focus on climate change and its relationship with health, this article argues that contemporary health promotion should be focused at the environmental ecosystem and concludes that a generation of researchers, practitioners and decision-makers needs to be familiar with the concepts of ecosystems and focused on settings that can promote both health and sustainability.

3 Websites

1. Global Conference on Health Promotion
The World Health Organization website provides a gateway to the most contemporary global conference and links to all the proceeding and key documents.

2. Principles and Practice of Health Promotion
This online learning resource contains useful information relating the principles and practice of health promotion.

3. Tools of Change
Tools of Change provides a very accessible set of resources for health promotion, including a planning guide, specific tools of change, and case studies. It works within a psychosocial model in comprehensive ways to address four of the five action areas within the Ottawa Charter. This introduction reviews Health Promotion in brief, and explains the fundamental principles built into this site.

3 Media Articles

1. Is the nanny state becoming too bossy?
This article debates the issue of regulating lifestyle using tobacco, drinking alcohol and wearing cycle helmets as examples.

2. Denmark imposes ‘fat tax’ on food to curb obesity
This article debates proposals to tax fat products in Denmark in an attempt of reduce consumption of fatty foods.

3. Empower people, don’t punish them
This article considers the issue of HIV using the concept of empowering women instead of victim-blaming them for acquiring HIV.