Health Promotion and Disease

Prevention

Introduction to Health Education

Prepared by Eshetie M.(MPH)

November 2017
 Module syllabus
• Module Title: Health Promotion and Disease
Prevention
• Module Code: SPH 201
• Module Description: The module is designed to equip
learners with the knowledge, skills and attitude needed
to promote health and prevent disease in individuals,
families and population.
• Module Objective
• At the end of this module, the students will be able to
apply principles and methods of health promotion to
improving the health of a population
• Prerequisite:
• (1) Measurement of Health and Disease and
• (2) Determinants of Health
• Duration: 20 weeks
• Teaching-Learning Methods
• Interactive lecture and discussion
• Small group learning activities: assignment, exercise, case study, role play
• Individual reading
• PHCU/Community-based learning and study trip: home visit, discussion
with individuals and families to identify and solve problems, observation,
health education, PHCU visit, Zonal and District Health Department Visit,
field visit, and targeted literature review based on community experience
• Student presentation
• Personal research and reflection exercise (PRRE)
• Reflective portfolio and mentoring
 Introduction to health education
Objective
At the end of this session, the trainees will be
able to:
• Explain the concept of Health.
• Define Health Education.
• State historical development of Health
Education.
• Describe objectives of Health Education.
• State basic principles of Health Education
 What is Health?
• Health is a broad concept which is difficult to
define and measure
• In different point of view health is considered
as
A reference for disease
Its boundary extends beyond the sick
The ability to lead socially acceptable &
economically productive live
 Cont….
• Many people consider themselves healthy if they
are free from disease or disability
• However, people who have a disease or disability
may also see themselves as being in good health
if they are able to manage their condition
properly
• The broad definition of health adopt by the WHO
in 1948 is comprehensive but difficult to apply
• “Health is a state of complete physical, mental
and social well-being and not merely the
absence of disease or infirmity”
 Aspects of health
Physical health
• Refers to anatomical integrity and
physiological functioning of the body
• To say a person is physically healthy
Ability to carry out daily tasks
All the body parts should be there in their
natural place and position
 Cont….
None of them has any pathology
All of them are doing their functions
properly and work with each other
harmoniously
 Cont….
 Mental health
• Ability to learn and think clearly
• Ability to handle day-to-day events and obstacles
• Work towards important goals
• WHO define mental health as “a persons ability
to recognize his potential and limitation, work
fruitfully and successfully, cope with stress,
establish and maintain relationship and
contribute to the society”
 Cont….
Social health
• The ability to make and maintain relationships
with other people or with significant others
• Ability to interact successfully with people and
within the environment in which each person
is a part
• Develop respect and tolerance for those with
different opinions and beliefs
 Additional aspects of health
Emotional Health
• Part of our overall health, concerned with the
way we think and feel
• The ability of expressing emotions in the
appropriate way
• It refers to our sense of well-being and our
ability to cope with life events
• Ability to respect and acknowledge our own
emotions as well as those of others
 Cont….
Spiritual Health
• Spirituality is unique to each individual
• Some people relate health with religion
• Belief in some force that serves to unite
human beings and provide meaning and
purpose to life
• Spiritual health is the innermost part of
you that allows you to gain strength and
hope
 Cont….
• All the above aspects of health are
interrelated and interdependent

• Physical problems can lead to mental

problems and vies versa therefore, health
should be viewed as a holistic concept
• Is the WHO definition of health holistic??
 Critics on WHO definition
 Health is dynamic, not a state

 The dimensions are inadequate

 Well being is very subjective

 Measurement is difficult

 Idealistic rather than realistic

 Health is not an end but a means

 Lacks community orientation

14
The absence of health is denoted by such terms as
disease, illness and sickness, which usually mean the
same thing though social scientists give them different
meaning to each.

• Disease is the existence of some pathology or

abnormality of the body, which is capable of
detection using, accepted investigation methods.

15
• Illness is the subjective state of a person who feels
aware of not being well.
• Sickness is a state of social dysfunction: a role that an
individual assumes when ill

16
Historic Development of Health Education

• In 1779 a German physician Johann Peter

Frank raised & propagated the
importance of supervising health of
school children as part of a school
education
• Health Education has become wide in
scope during the last 100 years.
 Cont….
• The growth & development of Health
Education has been accelerated with the
beginning of Primary Health Care concept
• Health education was put first in the
declaration of Alma-Ata (1978) as one of the
components of PHC
• It was recognized as a fundamental tool to the
attainment of “health for all by year 2000”
 Health Education in Ethiopia
• In Ethiopia, It is very difficult to know when
and where exactly health education was
started
• However, the development can be arbitrarily
divided into three periods
 Cont….
1. The period of the pre Ethiopian – Italian war
(before the 2nd world war)
• During the era of emperors Menelik II,
modern medicine had already been
introduced & started to expand in the
country
• The beginning of health education could be
related to the introduction of modern
medicine into the country
 Cont….
• Health education at this time was limited to
few hospitals available, to community leaders
& educated members of the community
• The primary focus was to increase the
awareness of people to modern medicine
and encourage them to utilize the services
 Cont….
2. The period After the Ethio – Italian war
(After the 2nd world war)
• The opening of Gondar public health college &
training centers (1954 E.C) was the most
important progress in the history of Ethiopian
health service
• This helped to train Ethiopian health
professionals in Ethiopia
 Cont….
• During this period
Medical services and training expanded
Mobile child health centres started to give
health education on child nutrition, personal
hygiene and others
Health centres were opened and the primary
objectives were to be involved in preventive
and curative activities.
 Cont….
3. The period of the socialist revolution &
after
• During this period the health services
have already expanded as compared to
the previous times
• Additional schools for training of doctors
and other health professionals were
opened
 Cont….
• In general, the concept & practice of health
education have further developed during the
last 20 years in Ethiopia
• Now a days, courses of health education is
included almost in all categories of health
professional training and
• The country utilizes health education as a
primary means of diseases prevention and
health promotion
 Concept of Health Promotion & Health
Education
• Many people use the term Health education
and Health Promotion interchangeably
• However there is a difference in concept
• Health promotion is broader than health
education
• Health education is an essential part of
health promotion
• An individuals’ health can be promoted by
giving them a health education
 What is Health education??
• Many authors provide different definitions of health
education
• According to Griffiths (1972), “health education attempts
to close the gap between what is known about optimum
health practice and that which is actually practiced.”

• Simonds (1976) defined health education as aimed at

“bringing about behavioral changes in individuals,
groups, and larger populations from behaviors that are
presumed to be detrimental to health, to behaviors that
are conducive to present and future health.”
 Cont…
• Health education is any combination of learning
experiences designed to facilitate voluntary actions
conducive to health (Green, 1991)
– Combination: emphasises the ‘importance of matching the multiple
determinants of behaviour with multiple learning experiences or
educational interventions’
– Design: distinguishes HE from incidental learning as a systematic
planned activity
– Facilitate means create favorable conditions for action.
– Voluntary action means behavioral measures are
undertaken by an individual, group or community to
achieve an intended health effect without the use of force,
i.e., with full understanding and acceptance of purposes
28
 Health Promotion

• Health promotion is the combination of educational

and environmental supports for actions and conditions
of living conducive to health

• In this definition:
– Combination refers to the importance of matching the
multiple determinants of health with multiple interventions or
sources of support

– Educational refers to health education

 cont....
• Environmental refers to the dynamic social forces than
the physical services.
– Such as: social, political, economic, organizational, policy,
and regulatory circumstances bearing on the behaviour or
more directly on the health

• Living conditions: referee to the complex web of

culture, norms and socioeconomic environment
associated with lifestyle
 Component of Health Promotion

• Health education
• Political environment
• Social environment
• Economic environment
• Organizational environment

31
 Scope / Dimension of Health Education

• The scope of health education is very wide

1. Touches upon many fields
• Its base is in medical sciences and its
development is related to other social or
behavioural sciences. Because of the main
concern of HE is to bring behavioural change
in the individual
 Cont….
• It works closely with other behavioural
sciences like psychology, anthropology
and sociology, that improve the
understanding of individual behaviours
 Cont….
2. A life long process
• The concern begins from birth
• Caring about a child begins while the
foetus is in the mother’s womb
3. Concerned about people at all points of
health and illness
• HE is required for almost every one
 Cont….
• Individuals, families, groups and communities
are targets of HE depending on the type of the
problem
• It is not limited to patients in clinical setup
• A patient with pulmonary TB needs
information that the disease could be
transmitted to other people, it is treatable and
the duration of treatment is long
 Cont….
4. Concerned with helping people to help
themselves
• It ranges from creating awareness up to
change in behaviour or creating
healthier conditions for everybody
• It is effective when based on the
cooperation of the target individual with
the health educator
 Cont….
• The health educator will teach individuals how
to keep or maintain their health, then they
will help them selves and others to be healthy
• Health education is not an end by itself it is
rather a way of
Empowering people to understand their
problems
Identify solutions and
Take appropriate actions
 Cont….
5. Involves formal and informal teaching and
learning methods
• Education on health could be given anywhere
depending on the purpose and circumstances
• A health educator can teach about HIV/AIDS
to a class of students in a school or for a group
of people gathered for a different purpose
 Cont….
6. Health is an asset for the individual and the
community
• Being healthy is valuable to an individual and a
healthy society has a potential to be productive
and wealthy.
• Creation of a healthy society is a goal for a nation
and governments are willing to spend more on
health care.
 Rationale for Health Education

1. Continued existence and spread of

communicable diseases that need
community involvement
2. Increasing threats to the young from
new and harmful behaviors e.g.
substance abuse
3. Health education is the only practical
option for some diseases
 Cont….
4. Increasing magnitude of chronic
diseases that require cooperation of
individuals
5. Increased awareness of people on
chronic health problems and the need
to know preventive actions
6. The cost of health care is rising
 Aim of Health Education

Promote health
Prevent illnesses
Self adjust to live with disabilities
Minimize avoidable deaths
Help each individual and family to achieve the
harmonious development of their physical,
mental and social wellbeing
 Goal of Health Education

1.Health consciousness goal

• Raise consciousness or awareness of health
issues
2. Knowledge Goal
• To give specific knowledge and information
3. Attitude change goal
• Changing what people feel, believe and
opinion
 Cont….
4. Decision making goal
• Involves both "knowing" and "feeling" objectives
• Deciding what to do in the future about health
5. Behavior change goal
• Carrying out a decision and actually doing
something about a health matter
• HE should bring permanent Change in behavior
which can be positive or negative
 Cont….
6. Social change goal
• Changing the social and physical environment
so that people are encouraged to adopt
healthier behavior
 Levels of disease prevention
• Health education can be applied at all three levels of
disease prevention.
1. Primary prevention
• Directed at healthy people
• The primary aim is to prevent occurrence of illness or
health problems
• At this level health education activities will focus on
changing behavior by raising awareness of the risk
factors that predispose the community members to
future health problems.
• For example, distribute insecticide treated bed nets
(ITN) to prevent the pregnant mothers getting
infected with malaria, Immunization…
 Cont….
2. Secondary prevention
• Given after the disease or problem has occurred
• The primary aim is to stop the progress of the
diseases to the severest forms
• At this level Health education includes
 educate people about their condition and what to do
about it
 to visit their local health centre/hospital when they
experience symptoms of illness such as fever, so they
can get early diagnosis and early treatment for their
health problems.
• At this level complete recovery from the diseases is
possible, but if neglected complications may occur
 Cont….
3. Tertiary prevention
• It is provided for patients with irreversible,
incurable and chronic conditions or after
permanent damage has set in
• The aim is to limit the impact of that damage
and prolonging of life
• Rehabilitation – retraining of the remaining
functions for maximum effectiveness
 Principles of Health Education
1. All HE should be need-based
• Specific and relevant to the problems
identified and the available solution
2. There is always some perception or belief
which should be studied first before HE
started
3. Find out the existing behavioral patterns and
their basis
 Cont….
4. HE should start from the existing culture and
gradually try to change the habit and practices
• Small changes in a graded fashion not at
once
5. HE should not become an artificial situation
• One has to get into the culture of the
community then introduce novel ideas
 Cont….
6. The process of education should be done step by
step
7. HE should provide opportunity for the clients to
go through the stages of identification of
problems and plan to solve it
8. A well planned program is necessary
• HE requires planning of resources, objectives,
identification of targets and others
• It is very difficult and unsuccessful carrying out
HE programs without a plan
 Cont….
9. Use of audio-visual aids for support and
reinforcement has significance in HE
10. There should be a free flow of
communication
• discuss freely on the health problems and the
solution
 Cont….
11. The health educator should
• Make himself acceptable
• Adjust his talk and action
• Use terms which can be easily understandable
• Make every effort to reason out
• Have a basic knowledge and fully familiar with
the subject matter
• Practice what he wants to talk about
 Health Education Settings

 Medical care institutions

 Communities
 Work site
 Special communities like schools, prisons and
refugee settings
• In Ethiopia the medical care setting and rarely
community and school settings are used
• Quite recently a few work site settings are used
for health education
 Who is responsible to provide health
education?
• All health professionals and those trained are
responsible to provide health education
• At a community level
Community health workers
Trained members
Leaders
Teachers are involved in providing health
education
 Challenges to the Process of Health
Education
1. HE is not considered important during
relatively healthy status
2. People are usually preoccupied with many
other important daily activities to support
their life
3. HE is closely related to behavioural change
and maintenance w/c is conditioned by many
factors and it takes time
 Cont….
4. There is a failure to see the value of health
teaching by some health professionals, they
make it as part of their routine professional
practice
5. Health education is much more than transfer
of information
• Without changes in attitude and behaviour it
remains as a useless exercise
 PRIMARY HEALTH CARE (PHC)

Definition & Back ground

• The international conference on PHC held at
Alma-Ata USSR (current Almaty, Kazakhstan) in
1978 defines PHC as
• Essential health care (practical and socially
acceptable) provided for individuals and the
community or made universally accessible for
them (through their participation and with
affordable cost) in order to promote health
and prevention of the disease
 Cont….
• Its approach is to bring health care as close as
possible to where people live and work
• Major objective of WHO in 1948 was: The
attainment of the highest possible level of
health by all people / health for all
• Due to political and socio-economic factors
between 1948 and 1978 WHO didn’t meet the
stated objectives
 Cont….
 The magnitude of health problems
 Inadequate distribution of health resources
 The previous strategies stressed only on curative
care and
 The community have not participated in the
actual service they receive
• All of these reasons and others called for a new
approach and concept of PHC
 Cont….
• In the 1978 meeting it was declared that the
PHC strategy is the key to meet the goal of
“Health for all by the Year 2000”
• Since the declaration of PHC, Health education
was identified as a primary means of "Health
for All"
• Its central role is improving community
participation in problem identification, priority
settings and making decisions
 Cont….
PHC COMPONENTS/ELEMENTS
• It has at least 8 elements
1. Health Education
2. Provision of Essential Drugs
3. Immunization
4. MCH/FP (Family Health)
5. Treatment of common/endemic diseases & injuries
6. Adequate supply of safe water & basic sanitations
7. Communicable diseases control
8. Food supply and proper nutrition
 Cont….
• In 1988 ten years after Alma-Ata, WHO, UNICEF
and other parties decided to review the program
• Most countries have made considerable gains in
 Improving the health or well-being of their
population
 Improvements in coverage, effectiveness and
quality of health service
 Immunization rates increased
 Decreasing infant, under five and maternal
mortality rates
 Cont….
• But, no country can solve all of its health
problems until 2000 and new problems
continue to emerge in every country
• Health for all remains a permanent goal of all
nations up to and beyond the year 2000.
Thank you