Case 1 – too many obese
workers
I. Health Promotion and the Ottawa
Charter
The Ottawa Charter is on the first international conference on Health
Promotion. The meeting took place on November 21 st 1986 and wanted to
achieve Health For All by 2000
The prerequisites/the fundamental conditions and resources for health are:
peace, shelter, education, food, income, a stable eco-system, sustainable
resources, social justice and equity improvement in health requires a
secure foundation in these basic prerequisites
A. Health promotion
Is the process of enabling people to increase control over, and to improve, their
health
Health is seen as a resource of everyday life, not the objective of living (as to
reach a state of physical, mental and social well-being you need to be able to
identify and realize aspirations, to satisfy needs, and to change or cope with
the environment)
Health promotion is not just the responsibility of the health sector but goes
beyond
Health promotion action includes/means:
Build healthy public policy
Create supportive environments
Strengthen community action
Develop personal skills
Reorient health services
B. Advocate
Health promotion aims at making all conditions (political, economic, social, cultural,
environmental, behavioural) favourable through advocacy for health
C. Enable
Health promotion action aims at reducing differences in current health status and
ensuring equal opportunities and resources to enable all people to achieve their
fullest health potential
D. Mediate
Professional and social groups and health personnel have a major responsibility to
mediate between differing interests in society for the pursuit of health
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,II. The role of obesity and lifestyle behaviours in a
productive workforce
Robroek article investigates the role of lifestyle factors in relation to the presence and degree of
productivity loss at work and sick leave. Lifestyle-related factors, especially smoking and obesity,
were associated with the presence and duration of sick leave and degree of productivity loss at work.
More than 10% of sick leave and the higher levels of productivity loss at work may be attributed to
lifestyle behaviours and obesity. Hence, primary interventions on lifestyle may have a noticeable
contribution to maintaining a productive workforce
A. Results
Many employers offer health promotion programmes to their workers, and it
has been estimated that over 80% of worksites with >50 employees offer some
kind of health improvement programme
BMI was associated with the presence of disease
Obese workers reported sick leave more often than workers with a normal body
weight
Insufficient physical activity was associated with productivity loss at work
The presence of sick leave in the past 12 months was also associated with
smoking, the presence of diseases, younger age and working in a mentally
demanding job
Smoking was associated both with 20% productivity loss at work
Lifestyle factors as well as health factors were associated with the presence of
sick leave and productivity loss at work
Obesity and smoking were associated with a higher level of productivity loss at
work and with more days off work due to health problems
Which employee populations benefit the most from worksite health promotion
interventions targeting weight and unhealthy behaviours?
The prevention of unhealthy lifestyle behaviours and obesity are important in
both physically and mentally demanding jobs
III. PRECEDE-PROCEED Model
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,The main purpose of the PRECEDE-PROCEED model is not to predict or explain the relationship
among factors through to be associated with a certain outcome, but it is about providing a structure
for applying theories and concepts systematically for planning and evaluation health behaviour
change programs it is a roadmap
It is an example of a logic model; which causal and action theories make up as programs theories
which are depicted as logic models
Logic models are depict proposed causal relationships among variables related to health
problems and their solutions
o A logic model of the problem or a theory of the problem depicts plausible causal
explanations of a problem
o A logical model of change, theory of change or intervention theory refers to a plausible
pathway of the mechanisms of change proposed for an intervention
A. Phase 1 – social assessment, participatory planning and
situation analysis
Planners try to understand the community in which they are working by conducting
multiple data collection activities (mostly qualitative methods, such as interviews
with key opinion leaders, focus groups with members of the community,
observations and surveys)
Concept mapping is a participatory method that allows the planner to obtain a
conceptual model of how people understand or feel about a particular topic or issue
B. Phase 2 – epidemiological, behavioural and environmental
assessments
This phase identifies the health priorities and their behavioural and environmental
determinants. The planner begins with building a logic model of the health problem /
wants to develop a causal model Usually describe the problems in a community
with help from existing data sources
1. Environmental assessment
Includes health problems and their related quality-of-life impact, behavioural
causes of the health problems, and environmental causes of the health
problem or risk behaviour Identifies the health problem, issues or aspirations Identifies the health problem, issues or aspirations
on which the program will focus
Uncovers the behavioural and environmental factors most likely to influence
the identified priority health issue
Translates those priorities into measurable objectives for the program being
developed
2. Behavioural assessment
Includes what the at-risk group does that increases risk of experiencing the
health problem
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, Most proximal are those behaviours or lifestyles that contribute to the
occurrence and severity of a health problem (for example, a teen
smoker’s tobacco use).
The second, more distal determinant is the behaviour of others who can
directly affect the behaviour of the individuals at risk (such as the teen
smoker’s parents keeping cigarettes in the home)
The third and most distal behavioural determinant is the action of
decision makers whose decisions affect the social or physical
environment that influences the individuals at risk (for example, actions
by police to enforce laws that restrict youth access to cigarettes)
3. Environmental analysis
Includes conditions in the social, physical and biological environments that
influence the health behaviour directly or through its behavioural causes.
They are beyond the personal control of the individual and can be modified
to support the behaviour or influence the health outcome
The environment plays a significant and modifiable role in causing the
problem either directly or indirectly
C. Phase 3 – Educational and ecological assessment
Health professionals explore the factors that produce the behavioural and
environmental conditions described in phase 2 So after selecting the relevant
behavioural and environmental factors for intervention, the framework directs
planners to identify the antecedent and reinforcing factors that should be in place to
initiate and sustain the change process
Predisposing factors: are antecedents to behaviour that provide the rationale
or motivation for the behaviour
o E.g. the individuals knowledge, attitudes, beliefs, values, and
perceptions that facilitate or hinder motivation for change
Reinforcing factors: are the factors that follow a behaviour that provide
continuing reward or incentive for the persistence or repetition of the
behaviour
o E.g. social support and peer influence
Enabling factors: are antecedents to behavioural or environmental change
that allow a motivation or environmental policy to be realised
o E.g. programs, services and resources
D. Phase 4 – administrative and policy assessment and
intervention alignment
The planner selects and aligns the program components and interventions that are
needed to effect the changes specified in the previous phases. The purpose is to
identify resources, organisational barriers and facilitators, and policies that are
needed for the programs implementation and sustainability
Building a comprehensive program requires:
Matching the ecological levels to broad program components
Mapping specific interventions based on theory and prior research and
practice to specific predisposing, enabling and reinforcing factors
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