Health education and health promotion
Week 2 – Chapter 2
Health, health education, health promotion and health policy
2.1 Health
• For centuries, health was defined in terms of the absence of physical disability. From
this medical-biological point of view, persons for instance suffering from chronic
diseases or a physical handicap were considered to be unhealthy.
An opposing position talks about personal perception and maintains that as long as
individuals perceive themselves as healthy, they are healthy (e.g. Kessener, 1982).
The most commonly accepted definition is that formulated in the WHO constitution of 1948:
health is a state of complete physical, social and mental wellbeing, and not merely the
absence of disease or infirmity.
Wellbeing includes such aspects as happiness and prosperity. This view on health is in
accordance with the work of Maslow (1968), a coryphaeus in humanistic psychology.
Maslow established a hierarchy of needs. He
assumed that people are motivated by unsatisfied
needs and that certain lower-level needs have to be
satisfied to some degree before higher needs can be
satisfied.
The basic needs related to physiological necessities
for survival. Safety needs have to do with
establishing stability and consistency in a chaotic
world. Love and belongingness are the next needs,
and refer to feeling loved and being accepted by
others. Self-esteem results from competence or
mastery of a task. Self-actualization refers to the
desire to become everything that one is capable of,
thus maximizing one’s potential.
It has only gradually been accepted that a person’s health is influenced by many factors.
These factors are generally referred to as determinants of health. We preferer to categorise
them into three groups: endogenous determinants, exogenous determinants, and the
prevalent system of health care (Ruwaard et al., 1994)
Endogenous determinants:
Are those that affect health ‘from the inside’. They refer to biological factors, which may be
hereditary (erfelijk) of acquired (verworven) in the course of life. Examples: gender or genetic
predisposition. Acquired factors are built up in the course of life, for example increased blood
pressure.
Exogenous determinants:
Refer to external influences on health and relate to physical environment, lifestyle factors and
social environment.
System of health care:
This refers to health service in relation to care, cure and prevention. It includes diagnostic
and treatment services, medical and nursing service etc.
,It is clear that the groups of determinants do
not occur in isolation. They interact with each
other, and together they influence the health
status of individuals and populations.
In this book we define health as a state
complete physical, social and mental
wellbeing, which enables people to lead an
individually, socially and economically
productive life.
2.2 Health education
Health education aimed to make individuals aware of the negative consequences for health
of their behavior. The emphasis was at all times on individuals, and on single behaviours, for
example ‘smoking or ‘eating’. Strategies to improve health were based on helping people to
form sound opinions and make good decisions.
However, practical experience confirmed by several studies (see Ajzen & Fishbein, 1980;
Geen et al., 1980; Koelen, 1988) have demonstrated that, while knowledge is an important
factor in inducing behavior change, it is not in itself enough. Motivation, skills, and perceived
self-efficacy are obviously important conditions as well. It is recognized that individuals
cannot be isolated from their material and social context and that the function of single
behaviours has to be considered in the wider context of lifestyles.
Medical approached:
Focus on the reduction of both morbidity and premature death (knowledge).
Persuasive approached:
Assumes that people can improve their health by choosing the change their lifestyle.
Individuals are encouraged to change their behavior in a certain direction seen as conductive
to health in the eyes of the expert (improve knowledge and positive skills they already have).
Participatory approached:
Focus on helping people to identify their own concerns and to gain the skills and confidence
act upon those concerns.
Health education today is defined as consciously constructed opportunities for learning,
involving some form of communication designed to improve health literacy, including
improving knowledge, and developing life skills which are conducive to individual and
community health (WHO, 1998; Nutbeam, 1998a). → together with (representatives of) the
target population.
2.3 Health promotion
At the first, International Conferences of Health Promotion in Ottawa, 1986, a Charter was
presented (WHO, 1986), which describes health promotion as the process of enabling
individuals and communities to increase control over, and to improve their health.
Health education is still considered to be an important device for the improvement of health,
but, as Kickbush (1986) states, it can only develop its full potential if it is supported by
structural measures such as legal, environmental, and regulatory ones (like smoking).
• Health promotion thus involves a broader area of action than health education alone.
Health education focuses on individual behavior.
,Five principles on which health promotion is based (Ashton & Seymour, 1988):
1) Health promotion actively involves the population in everyday-life settings
2) It is directed towards action on the causes of ill health
3) It uses many different approached
4) It depends particularly on public participation
5) Health professionals have an important part to play in nurturing health promotion
Involving populations:
This principles contains two important elements. Firstly, it shows that the focus is on
populations instead of on individual behavior. Secondly, it considers the notion of setting.
Action on causes of ill health:
This means that the focus is on prevention rather than on cure, but it also recognizes the
necessity of a broad approach, that is, that action should be directed at the social and
physical environment.
Different approaches:
Two action points in the Ottawa Charter (WHO, 1986) refer to this.
1. Develop personal skills
2. Build public policies that support health
Public participation:
This point refers to the notion of community participation. We used the term ‘community’ to
refer to specific groups with shared living needs, shared values, interests, cultural patterns
an social problems.
The role of health professionals:
The role of the health sector needs to move increasingly in the health promotion direction,
beyond its responsibility for providing clinical and curative services.
To summarise, health promotion brings together actions directed at strengthening the skills
and capabilities of individuals, and actions directed towards changing social, environmental
and economic conditions that may have an impact on public and individual health.
Health education still has a central place but it is realized that, in order to be successful, it
has to be supported by organizational, policy, and regulatory measures. Moreover, the
population itself should be actively involved.
2.4 Health policies
Health promotion is based on health policy. Policy refers to the set of objectives and rules
guiding the activities of an organization or an administration. Healthy public policies means
policies in the many and diverse fields shich support the promotion of health.
A distinction can be made between prevention policy, health care policy, and intersectoral
policy (cf. Ruwaard et al, 1994). → measures and activities aiming to prevent health
problems. There are three types:
1. Primary prevention
Aims to prevent health problems, diseases and accidents before they occur. It refers
to affect or remove the risk. For example: vaccinations and interventions.
2. Secondary prevention:
Aims to limit the course of a disease or to reduce the risk of recurrence. For example:
screening or monthly check ups.
3. Tertiary prevention:
Aims to prevent existing health problems becoming worse, and to reduce disability
due to health problems. For example: treatment, counselling and therapy.
, 2.4.1 WHO policy
In 1977, the WHO decided that the major social goal of
governments and WHO should be the attainment by all
people of the world by the year 2000 of a level of health
that would permit them to lead a socially and
economically productive life. According to the strategy
by the year of 2000 all people in all countries should
have at least such a level of health that they are
capable of working productively and to participating
actively in the social life of the community in which they
live (WHO, 1981).
1. The promotion of lifestyles conducive to health
2. Prevention of preventable conditions
3. Rehabilitation and health services
All countries had to make their own strategy to get
those 3 things done.
There where made 21 targets by the Europe regional
office of WHO, they were divided in to 5 groups.
Week 3 – Chapter 3
Theoretical background to health behavior
3.1 Perception
Many diseases are related to the way in which people behave and take care of their own
health. That’s why we do health promotion to improve people to take care of their own health.
But it is impotent to know why people act someway, some we can make a appropriate
promotion.
Perception is the process by which individuals receive information or stimuli from their
environment and transform it into psychological awareness. Although we live all in the same
world and see, hear and smell the same, all people have. Their own we to interpret their
experience.
• Firstly, perceptions are relative rather than absolute. A circle surrounded by larger
circle, will look smaller than the same circle that surrounds a smaller circle.
• Secondly, perceptions are selective. Some people memories something by smell
orders by sound.
• Thirdly, perceptions are organized. People tend to structure their sensory
experiences in ways that make sense to them.
3.2 Learning
We define learning as acquiring or improving the ability to perform a behavior pattern through
experience and practice.
3.2.1 The Law of Effect
A basic law of learning is the Law of Effect, that is: ‘an action which leads to a desirable
outcome is likely to be repeated in similar circumstances.’
In the Law of Effects approach, it is assumed that learning is an associative process that can
take place without active thinking. A central concept in the Law of Effect is reinforcement.
Reinforcement can be defined as any event whose occurrence increases the probability what
a stimulus will on subsequent occasions evoke a response (Hilgard et al., 1975).
