Health Promotion

Origins of Health Promotion

Health Promotion is related to
Epidemiology Public Health

Preventive Medicine

All tend to focus on the health of

populations rather than individuals, but each is different

These disciplines began with epidemics

Cholera
Cholera: bacterium Vibrio cholerae Transmitted by water & food

contaminated with fecal matter; death from dehydration & electrolyte loss Massive diarrhea kills 50%-60% within 2 hrs several days (many litres of fluid lost)

London Cholera Epidemic, 1854

Cholera Tx now: death is usually

prevented by re-hydration Then, Drs. dehydrated pts. with purgatives, bleeding; made pts. worse Several previous outbreaks 1854 epidemic was in the SOHO area Public water was taken from the Thames below a sewage outlet, wells seeped ground water

Deaths from Cholera, London, 1854

Snows Investigations
Deaths happened in a small area around

Broad, Lexington, & Poland Streets

Almost all who died drank from the pump
Snow did not know what caused Cholera the quantity of morbid matter which is

sufficient to produce cholera is inconceivably small

Low death rates from businesses nearby

which used their own wells

Choleric sewage water collected around

pump

Snows Conclusions
He concluded it was the pump water Asked local authorities to remove the

handle A few days following, epidemic stopped Most still did not believe it had been the water; looked, smelled, & tasted clean Sewage ponds continued in London for decades thereafter Robert Koch isolated cholera vibrio in 1883

Relevance to Today
The cholera outbreaks were best dealt with by

epidemiology, public health, and preventive medicine

Epidemiology: The branch of medicine

that deals with the study of the causes, distribution, and control of disease in populations. May or may not be concerned with behaviour: it focuses on illness

The goal of health promotion

One of the most widely accepted definitions of Health Promotion is given in the Ottawa Charter

for Health

"Health promotion is the process of enabling people to increase control over, and to improve, their

health."

Health, as defined by the World Health Organization in 1948, is:

"a state of complete physical, mental and social well-

being and not merely the absence of disease or infirmity."

Why health promotion?

directly to unhealthy lifestyles primarily:

Fifty percent of deaths and illness in Canada relate

poor diet tobacco use lack of exercise unmanaged stress

Health Promotion Service is responsible for

educating and assisting individuals and groups in maintaining or improving their health their state of well-being and move them toward a state of optimal health.

This includes promoting lifestyles that enhance

Health promotion in Canada

Health promotion in Canada

Medical level disease treatment E.g. a recovery program for people who have had heart attacks Raise funding for a cancer cure

Health promotion in Canada

Public health level Behaviour based disease prevention E.g. promotion of safe sex Drinking and driving campaigns Exercise awareness

Health promotion in Canada

Socioenvironmental level Social change public health policy (laws) E.g. poverty reduction policies School lunch programs Seatbelt legislation

Health promotion mechanisms

Self-care is an important concept
This refers to such things as diet, risk behaviours,

regular medical checkups and exercise

Self care does not work by itself it works best with

significant others in ones life

 Generally it is healthier to have

Health promotion mechanisms

other people around

Mortality rates are lower in

communities that have a higher level of social integration

People in close-knit

communities are healthier

Health promotion mechanisms

Social support comes in many forms and has been shown to affect survival rates among sick people
Naturally occurring social support
This is support from friends, relatives and coworkers

Agency-provided support
Provided by agencies and organizations when other

social support is lacking

Health promotion mechanisms

Practical support (tangible support)
This is help with everyday life Getting meals, transportation, money

Support from these sources can come in several forms

Informational support
Treatment options, recovery times

Emotional support
Provided by others in order to help deal with our

emotions when ill

Health promotion and theory

A good way to change health behaviours is to

change beliefs about the behaviours

2 main elements include: Peoples beliefs about their vulnerability to a threat The effectiveness of a given course of action to reduce the threat

Health promotion and theory

This information can be passed on in

promotional ways
Include information on vulnerability Include information on prevention and

preventative behaviours

Fear Appeals
Changing ones attitude, belief or

behaviour can be done through scare tactics

This intensifies beliefs about

peoples vulnerability to the threat

The perception of the threat is more

important than actual fear

Fear Appeals
The effectiveness of fear appeals depends on peoples

responses when frightened Fear control a response where people use emotionfocused coping to reduce their personal discomfort brought about by the information Constructive change usually does not occur

Fear Appeals
Danger control This leads to constructive changes in

health behaviour This is a form of problem focused coping People will change their behaviour to alter the situation and reduce stress and danger Generally they will reduce their risk

Leading Causes of Death In Canada, 1997

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Leading Causes of Behaviour-Related Deaths In Canada

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Tobacco use is Canada's Number One cause of preventable death* It causes 25% of all deaths in Canada More than 1,000,000 Canadians alive today will die from smoking Tobacco marketing targets children Smoking is associated with other drug use 68% of early school leavers are smokers
*Laboratory Centre for Disease Control, Health Canada

40 35 30 25 20 15 10 5 0 85

Estimated Current Smoking Rate Canadians Aged 15 and Older

Percent

87

89

91

Estimated Current Smoking Rate Canadians Aged 15 and Older

Year

93

95

97

99

StatsCan cat#82F0077XIE

California Tobacco Control Program [1]

A large, aggressive campaign funded by a cigarette surtax of 25 cents / pack 5 cents / pack were allocated for an anti-tobacco educational campaign From 1989-1993

California Tobacco Control Program [2]

Per capita cigarette consum ption (packs / year)

160 140 120 100 80 60 40 20 0

19 80 19 81 19 82 19 83 19 84 19 85 19 86 19 87 19 88 19 89 19 90 19 91 19 92 19 93 19 94 19 95 19 96 19 97
Aggressive campaign period

California
Source: Fichtenberg. (2000). N Engl J M. 343(24): 1772-1777

USA, excluding California

California Tobacco Control Program [3]

Data suggest that the program accelerated

the decline of cigarette smoking

Smoking prevalence in California has

dropped 32% since 1988

The program was associated with 33,000

fewer deaths than expected from heart disease between 1989 and 1997
Source: Fichtenberg. (2000). N Engl J M. 343(24): 1772-1777

California Tobacco Control Program [4]

Before the program
Prevalence of smoking was declining at a

similar rate in California (0.74% / yr) and the rest of the US (0.77% / yr)

After the program

The rate of decline in prevalence accelerated

in California (1.06% / yr), but slowed in the rest of the US (0.57% / yr)
Source: Fichtenberg. (2000). N Engl J M. 343(24): 1772-1777

Summary
The best way to reduce morbidity/mortality Health Promotion focusing on: Smoking, Alcohol abuse, Fitness levels, Eating and Nutrition Shows the greatest impact on human health Research is ongoing, much more

needed