Conceptualising

Health Promotion –
theory and principles

Associate Professor Frank Tesoriero

Department of Public Health
Flinders University
2011
Identify a health behaviour
in yourself

What has influenced you

to behave that way?
Wh t iis theory?
What th ?

“Systematically
Systematically organised knowledge applicable
in a relatively wide variety of circumstances
devised to analyse,
analyse predict
predict, or otherwise explain
the nature or behaviour of a specified
set of phenomena that could be used
as the basis of action”
Van Ryan and Heany,1992
Health Promotion Interventions

Individual Focus Population Focus

Screening Health Health Social Organis
Organis- Community Economic
Individual risk information education, marketing ational action and
assessment counselling develop- regulatory
and skill ment activities
d
development
l t

Medical approach
pp
Behavioural approach

Socio environmental approach

Socio-environmental
Commentary on three models

 Not mutually exclusive options.

 Each needs the other - they are
interdependent.
 Debate is about appropriateness and
balance.
balance
 Framework for Health Promotion Action
INTERVENTIONS

Downstream Upstream

Primary Communication Health Community & Infrastructure &

Disease Strategies
g Education & Primary Health Systems
Prevention Empowerment Development Change

Screening Health Engagement

Information Knowledge Policy
Risk Community
Assessment Behaviour Understanding Action Legislation
Change
Immunisation Campaigns Skill Advocacy Organisational
development Change

Primary Lifestyle/Behaviourist Socio-ecological Approach

Care Approach
Approach
Murphy B & Keleher H (eds) Understanding Health: a determinants perspective, Melb, OUP,
2003
Promoting change in health status
Intervening in the chain of the social production of health

How change in health status is promoted can be represented along a continuum

and the entry point for policy and program action can be mapped accordingly …
there are several entry points along the chain of production:

Decreasing social stratification itself, by reducing “inequalities in power,

prestige, income and wealth linked to different socioeconomic positions

Decreasing the specific exposure to health-damaging factors suffered by

l iin di
people d t d positions
disadvantaged iti

Lessening the vulnerability of disadvantaged people to the health-damaging

conditions
diti th
they fface

Intervening through healthcare to reduce the unequal consequences of ill-

health and prevent further socio
socio-economic
economic degradation among disadvantaged
people who become ill
Commission on Social Determinants of Health (2005). Action on the social determinants of health: learning from previous experiences,
Background Paper, Geneva, World Health Organisation, p. 40.
 A example
An l - smoking
ki

1
1. What things do we know about smoking?
2. How systematic is the knowledge?
3
3. Where can we apply that knowledge?
4. Can we analyse, predict or explain using the knowledge?
5
5. Can we act in any ways
ways, based on that knowledge?
6. Can we ‘name’ a theory we are using?
Th
Theory and
d health
h lth promotion
ti

 Theory can guide how we develop health promotion

activities, programs, interventions

Theory can help

Th h l predictdi t iissues th
thatt may arise
i and
d
help to explain difficulties

 There are p
program
g management
g g
guidelines for health
promotion. Referring to theory can guide health
promoters through
p g the stages
g of p planning,
g
implementation and evaluation.
 Health Promotion planning and evaluation cycle
Theory helps to identify
what are targets for
intervention 1
Problem definition
(redefinition) 7
Theory helps to clarify how and Outcome
when change can be achieved
in targets for intervention 2 assessment
Solution
generation
6
Intermediate
3
outcome
Resource
Theory indicates how to achieve assessment
organisation change and raise mobilisation
community awareness
5
4
Impact Theory defines outcomes
Implementation and measurements for use
assessment in evaluation
Theory provides a benchmark
against which actual can be
compared with ideal program

Nutbeam and Harris, 1999, p12

 The use of theory
y in
program planning
l i and d evaluation
l i
Planning phase Task Possible use of theory
Problem identification Clarify major health issues for a defined Clarify what should be the target
and priotisation population, and prioritise in terms of the elements of an intervention, such
potential for effective intervention as individual beliefs, social norms
or organisational practices

Planning a solution Develop a program plan which specifies Guidance on how and when and
program objectives, strategies and the where change can be achieved in
sequence
q of activity
y the target
g elements of a p
program
g

Mobilising resources Generate public and political support, build Guidance on how to build
for implementation the capacity of partner organisations and partnerships, raise public
secure resources awareness and foster
organisational development

Implementation Execute the program as planned, utilising Provide a benchmark against

multiple strategies (as appropriate to the which the actual implementation
program objectives)
objecti es) can be compared withith the
theoretically ideal

Evaluation Assess the impact and outcome of the Define outcomes and
program according to predefined program measurements which could be
objectives used at each level of evaluation

Nutbeam and Harris, 1999, p17

Three approaches
pp to enhancing
g health

1. Medical or High Risk approach

2. Behavioural or Multi Risk

F t approachh
Factor

3. Socioenvironmental or
Community Development
approach
h
 Medical approach
pp
Health concept Problem definition Principal strategies Target
Negative
g state,, Disease and Surgey,
g y, High
g risk individuals
absence of disease, physiological risk Drug, other therapies
disability or other factors Medically managed
‘deviance’ from health behaviour
physiological ‘norms’ change
Screening for
physiological risk
factors
Program Prevention level Success rate
development
Professionally Tertiary prevention Disease is diagnosed
managed Disease intervention Morbidity
Decrease in specific
age-standardised
mortalities
Decrease in risk
factor
Prevalence rates
 Behavioural approach
Health concept Problem definition Principal strategies Target
Individualised, health Behavioural risk Health education High risk groups:
as ‘energy’ physical- factors Social marketing (those with unhealthy
functional ability Health advocacy for lifestyles)
policy supporting Children
lifestyles change (promotion of healthy
lifestyles)
Program development Prevention level Success rate
Community-based programming: Secondary prevention Improved existing
Professional and/or agencies defining the (impro ing lifest
(improving lifestyles)
les) lifest les
lifestyles
health problem, developing strategies, Primary prevention Healthier lifestyles ‘early
involving local community members and (creating healthy in the life cycle’
groups Working to transfer major
groups. lifestyles) Enactments of healthy
responsibility for ongoing program to local public policies related to
community members and groups health behaviours
 Socioenvironmental approach
pp
Health concept Problem definition Principal strategies Target
Positive state, connectedness Psychosocial risk Personal High risk
t one’s
to ’ f t
factors and
d empowermentt environments
i t
family/friends/community, self socioenvironmenta Small group
efficacy, ‘being in control’, l risk conditions development
ability to do things that are Community
important or have meaning, organisation
psychological and social Health advocacy
‘wellness
wellness.’ Political action
Program development Prevention level Success rate
Community development Primaryy Improved personal perception of health
programming: prevention Improved social networks, social support
Enabling communities to make (creating healthy Improved community actions to create more
decisions necessary to plan equitable social distribution of
lifestyles)
and implement strategies to power/resources
achieve better health, which Health promotion Improved community actions to create more
requires allowing communities (creating healthy environmentally sustainable personal, pubic
to define their own priority living conditions) and private economic practices
Labonte 1992,
health problems Shifts in social equity measures in the pp121-22

direction of greater equity

A continuum from health promotion
to disease prevention
OPTIMAL HEALTH

Socio ecological
health promotion
Health Effecting enduring social change Primary health
promotion
oriented Community action
(health field) Raising individual quality of life S
Secondary
d
promotion
health
h lth
Participatory
Primary disease Tertiary health health education
Eradicating health risks
prevention
p promotion
p
Health education
2ndary disease Early treatment Disease and behaviour
oriented
prevention change

Tertiary disease Care and rehabilitation (medical field) 1ary care/disease

prevention prevention

MINIMAL DISEASE