Chapter one

Introduction

Znabu Hadush (MPH, Ass’t Professor of Health

Promotion)
School of Public HPalth
2023
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1 LEARNING OBJECTIVES

1 Understand definitions and principles

of Health Promotion

Review the historical development

2 of HP in Ethiopia

Explain determinants of health

3
Aims, Challenges, approaches and rational of
4 HPalth-education
 Definition terms/concepts
[Link]
Health is a broad concept which is often difficult to define and
measure. Its boundary goes beyond sickness.
It depends on:
1) The perception of individuals
2) The threshold - e.g. pain
3) the ability to recognize symptoms and signs

WHO definition (1948),

HPalth is a state of complete physical, mental and social
wellbeing not merrily the absence of diseases or infirmity
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 Aspects of Health
Physical health: How healthy your body is.
o It is the absence of diseases or disability on the body parts .

o It is the biological integrity and the physiological well functioning of the

human body
o It is the ability to perform routine tasks without any physical restriction.

Social health:
o Is the ability to make and maintain “acceptable” and “proper”

interaction and communication with other people and the social

environment; satisfying interpersonal relationship and role
fulfillment
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Mental health: Concerned with ability of mind to think and
understand coherently. Mentally healthy person shows growth and
maturity into two areas

 Cognitive:
 It is the ability of an individual to learn, perceive and think clearly.

 Emotional:
 A mental process involved with a state of emotions. E.g Happiness,
sadness…

 It is the ability of expressing emotions in an appropriate way.

The response should be matching with that of the stimuli.
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 Spiritual health: It is currently extended dimension of health.
For some people connected with religious beliefs and practices;
for others it has to do with personal beliefs, principles of
behavior and ways of achieving peace of mind.

 All the above aspects of HPalth are interrelated and

interdependent.

 The approach helps health professionals and community

members to realize and act accordingly based on the
multiple factors that affect HPalth directly or indirectly.
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 Holistic concept of health
 Quality of life that has dimensions and is being influenced by
many factors

 Interdependent and inter- related each other

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 Determinants of health cont..
There are four general determinants of health
(according to health field concept)
 Human biology
 Environment
 Lifestyle
 HPalth care services

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 Determinants of Health

Canadian Institute of Advanced Research

(2012)

Health care
(up to 25%)

Socioeconomic (50%)

Environmental (10%)

Genetics (15%)

Figure: Estimates of the contribution of the main drivers of HPalth status.

Source: Donkin, A., P. Goldblatt, J. Allen, V. Nathanson and M. Marmot (2017).

"Global action on the social determinants of HPalth." BMJ Global Health.
 Determinants of Health

Social determinants of health

• Conditions in which people are born, grow,
live, work and age

• These circumstances are shaped by the

distribution of money, power and resources at
global, national and local levels

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SOCIAL DETERMINANTS OF HEALTH

Source: Dahlgren G and Whitehead M (1991)

Policies and strategies to promote social equity in
health. Stockholm, Institute of Future Studies.
 Determinants of Health…

Income and social status - higher income and

social status are linked to better health

Education – low education levels are linked

with poor health, more stress and lower self-
confidence

Physical environment – safe water and clean

air, HPalthy workplaces, safe houses,
communities and roads all contribute to good
health
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 Determinants of Health…

Social support networks: greater support from families,

friends and communities is linked to better health

Genetics: inheritance plays a part in determining lifespan,

healthiness and the likelihood of developing certain
illnesses

HPalth care services: access and use of services that

prevent and treat disease influences health

Gender: Men and women suffer from different types of

diseases at different ages

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 Health maintenance
 Achieving health and remaining healthy is an active
process
 Effective strategies for staying healthy and improving
one's health include the following elements:

Nutrition
• What people eat affects their HPalth and
performance, such as foods or food components that
cause diseases or deteriorate health

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 Health maintenance con…
Exercise
• Frequent and regular physical exercise is an
important component in the prevention of some of
the diseases

Hygiene and sanitation

• Hygiene is the practice of keeping the body clean to
prevent infection and illness, and the avoidance of
contact with infectious agents

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 Health maintenance con…
Stress management
• Prolonged psychological stress may negatively
impact health, such as by weakening the
immune system

Health care
• Health care is the prevention, treatment, and
management of illness and the preservation of
mental and physical well being through the
services allied HPalth professions
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 Health maintenance con…
According to the WHO, health care embraces all the goods
and services designed to promote health, including
“preventive, curative and palliative interventions,
whether directed to individuals or to populations”

Workplace wellness programs: can include things like

onsite fitness centers, HPalth education, access to health
coaching, tobacco cessation programs
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Determinants of Health Behavior

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 Level of Diseases Prevention

Prevention: is planning for and the measures taken to forestall the

onset of a disease or other health problem before the occurrence of
undesirable health events. There are three levels of prevention

Primary prevention: is directed toward preventing the initial occurrence of

a disorder.

Secondary prevention: seeks to arrest or retard existing disease and its

effects.

Tertiary prevention: seeks to reduce the occurrence of relapses and

rehabilitative
Relapse prevention includes specific clinical strategies designed to HPlp
clients achieve their substance use and mental HPalth goals.

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healthy onset of advanced disability
person symptoms symptoms death
(reversible) (not reversible )

Primary Secondary Tertiary

prevention prevention prevention
exercises screening rehabilitation
case finding
early prevention
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 Health education definition
 Health education is a combination of learning experiences
designed to facilitate voluntary actions conducive to
health

(Lawrence Green 1980).

Combination: the importance of matching the multiple
determinants of behavior with multiple learning experiences
or educational interventions.
Designed: HPalth education from incidental learning
experiences as a systematically planned activity.
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 Health education….

Facilitate: means create favorable conditions for

action( predispose, enable, and reinforce)
Voluntary: means without coercion and with the full
understanding and acceptance of the purposes of the
action.
Action: behavioral steps taken by an individual, group
or community to achieve an intended HPalth effect.

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 Health Promotion
HP is the combination of educational and environmental
supports (organizational, political and economic) for actions
conducive to health.
Green and Kruetr 1991
Combination: Matching multiple determinants of health
with multiple intervention or sources of supports.
Educational: refers to the communication part of HP; i.e HP.
Environmental: refers to the social, political, and
economic, organizational, policy and regulatory
circumstances influence behavior or more directly health.
Create environments that support good HPalth practices,
behaviors
HP= HP + Environmental support
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 Health Promotion cont…
 Health promotion is the science and art of helping
people to change their lifestyle to move toward a state
of optimal health
Strategies for implementation of Health promotion.
 HPalth education, Health communication
 Advocacy
 social mobilization
 social marketing
 IEC and BCC/SBCC
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 Key areas of health promotion

Five Key Action areas

1. Reorient health services
2. Create a supportive environment
3. Develop personal skills
4. Strengthen community action
5. Building HPalthy public policy

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 Rationale for health Promotion

o Continued existence and spread of communicable

diseases that need community involvement
o Increasing threats to the young from new and harmful
behaviors. e.g., substance abuse
o About 75% of childhood illnesses are preventable
o Health education is the only practical option for some
diseases e. g., HIV/AIDS
o The cost of HPalth care is rising
o Increased awareness of people on chronic health
problems and the need to know preventive actions
o People’s ignorance of causes of their illnesses

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 Aims of Health Promotion

 To promote the proper use of health services

available to them
 To encourage people to adopt and sustain health
promoting life style and practices
 To arouse interest, provide new knowledge, improve
skills and change attitudes in making rational
decisions to solve there own problems
 To stimulate individual and community self-reliance
and participation to achieve HPalth development
through individual and community involvement at
every step

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 Dimensions of health education
1. Multidisciplinary in nature

2. Health Promotion is a life long process: from birth to

death, helping people to change and adapt at all stages

3. Health education is concerned with people at all

points of health and illness
– From the completely HPalthy to the clinically sick and
handicapped

4. Health education is not an end by itself: rather a way

of empowering people

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 Principles of HP cont…
Principle of definite aim
• Health educator should have well defined objectives
• The goals to be reached should be specified

Principle of Interest
• It is a psychological principle that people are unlikely
to listen to those things, which are not to their interest
• HPalth educators must find out the real health needs of
the people(felt needs)

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 Principles of HP cont…

Principle of Credibility
• Good health education is based on facts-that
means it must be consistent and compatible with
scientific knowledge and also with local culture
and educational system and social goals

• Unless the people have trust and confidence in the

communicator, no desired action will ensure after
receiving the message
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 Principles of HP cont…

Principle of Participation
• Participation is a key word in Health education

• It is based on the principle of active learning

• A high degree of participation tends to create a sense

of involvement, personal acceptance and decision
making.

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 Principles of HP cont…

Principle of Motivation
In every person there is a fundamental desire to learn
Awakening this desire is called motivation
There are two types of motives-
• Primary motives are driving forces initiating people
into action: these motives are in born desires
• Secondary motives are based on desires created by
out side forces or incentives
• Motivation is contagious; one motivated person may
spread motivation through out the group

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 Principles of HP cont…

Principle of Comprehension
• In health education we must know the level of
understanding, education and literacy of the
people to whom the teaching is directed

• We should always communicate in the

language people understand. Teaching should
be with in the mental capacity of the audience

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 Principles of HP cont…

Principle of Reinforcement
• Few people can learn all that is new in a single
period.
• Repetition at intervals is necessary.
• If there is no reinforcement, there is every
possibility of the individuals going back to the pre-
awareness stage

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 Principles of HP cont…

Principle of Learning by Doing

• Learning is an action- process; not a
memorizing one in the narrow sense
• The Chinese proverb: “If I HPar, I forget; if I
see, I remember; if I do, I know” illustrate the
importance of learning by doing

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 Principles of HP cont…

Principe of Known to unknown

• In health education work, we must proceed
“from the concrete to the abstract”; from the
particular to the general”; “from the simple to
the more complicated”; “from the easy to more
difficult”; and “from the known to unknown”
These are the rules in teaching.

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 Principles of HP cont…
Setting an example (Role model)
► Health educator should set a good
example in the things HP/she is
teaching.
► Must be a role model to his/her
clients

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 Principles of HP cont…

Principle of good human relations

 Sharing of information, ideas and feelings happen most
easily between people who have a good relationship
 Building good relationship goes hand in hand with
developing communication skills

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 Principles of HP cont…

Principle of Feedback
Feedback is one of the key concepts of the systems
approach. For effective communication feedback is of
paramount importance

Community leaders
►Psychologist have shown and established that we
learn best from people whom we respect and regard.
►In the work of HPalth education we try to penetrate
the community through the local leaders.

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 Challenges of health education process
 People are usually preoccupied with many other
important daily activities
 There is a failure to see the value of health
teaching by many health professionals
 Health education is not considered important
during normal life. People are concerned about
diseases
 Largely related to behavior; changing behavior
is conditioned by many factors: social,
psychological, economic, cultural,
accessibility and quality of services, political
environmental
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 References
 John Hubley 1993. Communicating health. An
action guide to health education and health promotion.
 Lawrence W. Green et al. 1980. Health education
planning a diagnostic approach
 Randall R. Cottrell, James T. Girvan, James F.
McKenzie 2006. Principles& foundations of health
promotion and education. Third ed. USA.
 John Hubley 1993. Communicating HPalth. An
action guide to health education and HPalth promotion.

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 Thank you.

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