Introduction to Health Studies
Health Promotion I
Dennis Raphael
School of Health Policy and Management
York University, Toronto, Canada
Overview of Today’s Presentation
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Differing Concepts of Health Promotion
Canadian Contributions
The Ottawa Charter for Health Promotion
Current Approaches to Health Promotion
Reflection: The Role of Values
Class Exercise: How Should We Reduce the
Incidence of Heart Disease?
Defining Health:
The Medical Definition
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The normal physical state, i.e., the
state of being whole and free from
physical and mental disease or
pain, so that the parts of the body
can carry on their proper function.
Defining Health:
The World Health Organization
• Health is a state of complete physical,
mental, and social well-being and not
merely the absence of disease and
infirmity.
• Health is a positive concept
emphasizing personal resources, as
well as physical capacities.
Three Broad Concepts of Health
• Medical (Traditional)
• Behavioural (Lifestyle)
• Socio-Environmental (Structural)
• These approaches lead to different
definitions of problems, different
strategies, different target groups, and
different people responsible for the
activities of promoting health.
Concepts of Health Promotion:
Medical Approach I (Traditional, Biomedical)
• Health Concept is biomedical, absence of
disease and/or disability
• Leading Health Problems defined in terms
of disease categories and physiological risk
factors such as physiological deviation from
the norm: CVD, AIDS, diabetes, obesity,
arthritis, mental disease, hypertension, etc.
Concepts of Health Promotion:
Medical Approach II
• Principal Strategies: surgical interventions,
drug and other therapies, health care, medically
managed health behaviour change (diet, exercise,
patient education, patient compliance), screening
for physiological and genetic risk factors
• Target: high risk individuals
• General Approach: Individualized
• Actors: physicians, nurses, allied health workers
Concepts of Health Promotion:
Behavioural Approach I (Lifestyle, Public Health)
• Health Concept is individualized, health as
energy, functional ability, disease-preventing
lifestyles
• Leading Health Problems defined in terms
of behavioural risk factors: smoking, poor
eating habits, lack of fitness, drug abuse,
alcohol abuse, poor stress coping, lack of
lifeskills, etc.
Concepts of Health Promotion:
Behavioural Approach II
• Principal Strategies: health education, social
marketing, advocacy for public policies supporting
lifestyle choices (e.g. smoking bans,
low fat meat production, bicycle paths, ad bans)
• Target: high risk groups, children and youth
• General Approach: individualized, elements of
societal focus as related to public policy
• Actors: public health workers, illness-related
advocacy groups (e.g., Cancer Society),
governments
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Concepts of Health Promotion: SocioEnvironmental Approach I (Structural)
• Health Concept is a positive state defined in
connectedness to one's family/friends/community,
being in control, ability to do things that
are important or have meaning, community and
societal structures supporting human development
• Leading Health Problems defined in terms of
psychosocial risk factors and socio-environmental
risk conditions: poverty, income gap, isolation,
powerlessness, pollution, stressful environments,
hazardous living and working conditions, etc.
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Concepts of Health Promotion: SocioEnvironmental Approach II (Structural)
• Principal Strategies: small group development,
community development, coalition building,
political action and advocacy, societal change
• Target: high risk societal conditions
• General Approach: structural, focussed on
organization of communities and society,
development of just political/economic policies
• Actors: citizens, social development and welfare
organizations, political movements and parties
Canadian Contributions I
• Lalonde Report - 1974
A New Perspective on the Health of Canadians
• Health Field Concept:
– Human Biology
– Lifestyle
– Environment
– Health Care
Canadian Contributions II
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Epp Report - 1986
Achieving Health for All
• Challenges: Reducing inequities, increasing
prevention, enhancing coping
• Mechanisms: self care, mutual aid, and healthy
environments.
• Strategies: public participation, strengthening
services, coordinating healthy public policy
Canadian Contributions III
• Healthy Cities Movement was developed in
Toronto, and is now very strong in Europe
• The Healthy Cities approach incorporates a broad
definition of health, one that emphasizes
prevention of community problems and the
development of people.
• Health encompasses all aspects of people's lives
including housing, education, religion,
employment , nutrition, leisure and recreation,
health and medical care, good transportation, a
clean and green environment, friendly people, and
safe streets and parks that promote a Healthy City.
The Ottawa Charter for Health Promotion
– World Health Organization, 1986
• Health is a positive concept emphasizing social and
personal resources as well as physical capacities
• Health Promotion is the process of enabling people
to increase control over, and to improve their health
• Prerequisites for Health are peace, shelter,
education, food, income, stable ecosystem,
sustainable resources, social justice and equity
• Health Promotion Actions are: building healthy
public policy, creating supportive environments,
strengthening community action, developing
personal skills, reorienting health services