Chapter 4 - HEALTH PROMOTION AND
DISEASE PREVENTION
Risk Reduction
A risk reduction is proactive process in which
individuals participate in behaviour that enable
them to react to actual or potential threats to
their health – Pender, 1996
Risk- the probability that a specific event will occur in a
given time frame – Oleckno, 2002
Risk Communication
Risk Factor- on exposure that is associated with a
disease – Friis and Seller, 2004
A risk communication is the process through
which the public receives information regarding
possible or actual threats to health.
Two Types of Risks
Modifiable risk factors- are those aspects of a
person’s health risk over which he or she has
control.
Diet
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Example: include smoking, leading sedentary or active
lifestyle, type, and amount of food eaten, and the type of
activities in which he or she engages.
Nonmodifiable risk factors- are those aspects
of one’s health risk over which one has no or
little control.
Example: include genetic made-up, gender, age, and
environment experience.
Obesity
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Three Criteria for Establishing a Risk Factor
1. The frequency of the disease varies by
categories or amount of the factors. Cigarette
smokers are more likely to develop lung cancer
that non-smoker and those who smoke heavily
are more likely to develop lung cancer than
those who smoke little.
2. The risk factor must precede the onset of the
disease. Cigarette smokers have lung cancer
after they have been smoking for institute. If
smoker has lung cancer before starting to smoke,
this would cast doubt on smoking as a risk factor
for lung cancer.
3. The association of concern must not be due to
any source of error. In any research study,
(especially one involving human behaviour)
there are many sources of error such as study
designs data collection methods, and data
analysis.
The four main steps of a risk assessment are:
1.
2.
3.
4.
Hazard identification
Risk description
Exposure assessment
Risk estimation
Risk Assessment
A risk assessment is a systematic way of
distinguishing the risks posted by potentially
harmful exposures.
One of the most modifiable of risk factors. A
healthy diet contributes to the prevention of such
chronic disease as type 2 diabetes, hypertension,
heart disease, and some cancers.
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Obesity affecting the Filipino adults is known as
android or apple-shaped type, where abdominal
fat accumulation is measure using waist-to-hip
ratio (WHR).
A person with WHR equal to or more than 1.0 in
men or equal to or more than 0.85 in women is
considered android or apple-shaped obese
(FNRI, 2021)
The WHR criterion recommended by the World
Health Organization is considered as a sensitive
measure for risk to cardiovascular disease
(CVD).
The relative risk associated with apple-type
obesity among Filipinos was found to be more
than twice the risk of developing coronary artery
disease and almost thrice the risk of developing
CVD including stroke. These account for at least
37,000 deaths in 2008 (FNRI, 2012).
Nutritional Guidelines for Filipinos (from the FNRI)
1. Eat variety foods every day.
2. Breast-feed infants exclusively from birth to 4-6
months and then, give appropriate foods while
continuing breast-feeding.
3. Maintain children’s normal growth through
proper diet and monitor their growth regularly.
4. Consume fish, lean meat, poultry or dried beans.
5. Eat more vegetables, fruits and root crops.
6. Eat foods cooked in edible/cooking oil daily.
7. Consume milk, milk products and other calciumrich foods such as small fish and dark green
leafy vegetables every day.
8. Use iodized salt, but avoid excessive intake of
salty foods.
9. Eat clean and safe foods.
10. For a healthy lifestyle and good nutrition,
exercise regularly, do not smoke and avoid
drinking alcoholic beverages.
Increasing Physical Activity
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Research has found that one’s environment is a
significant factor in health promotion.
Adults and adolescents living in neighbourhoods
with high walkability engage in significantly
more walking and cycling than those living in
neighbourhoods with low walkability – Frank,
2005; Saelens et. al., 2003
The Sightline Institute (2008) has formulated a
walk score algorithm to rate U.S. cities for
suitability for walking.
Components for Suitability of a City for Walking
(from the Sightline Institute)
 A center; a shopping center, park, or main street.
 Mixed use, mixed income; business are located
next to homes at all price points.
 Pedestrian-centric design; business are close to
the street to encourage foot traffic with parking
in back.
 Density; the city is compact enough to allow
business to flourish and for public transportation
to run frequently.
 Parks and public space; there are plenty of
public areas in which to gather
 Nearby schools and workplace: school and
workplaces are close enough that most people
can walk from home.
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Sleep
Sleep is an essential component of chronic
disease prevention and health promotion, yet
74% of adults report having a sleeping problem
one or more nights per week.
Insufficient sleep s associate with diabetes, heart
disease, obesity, depression, and motor vehicle
accidents.
As we age, sleep if often interrupted by pain,
trips to the bathroom, medication, medical
conditions, and sleep disorders.
How Much Sleep Do You Really Need?
Age
Newborn (1-2 months)
Infants (3-11months)
Toddlers (1-3years)
Preschoolers (3-5years)
School-aged (5-12years)
Teens (11-17years)
Adults
Older adult
Sleep Needs
10.5-18 hours
9-12 hours during night and
30-minute to two-hour naps,
one to four times a day
12-14 hours
11-13 hours
10-11 hours
8.5-9.25 hours
7-9 hours
7-9 hours
Sleep Hygiene (from the National Sleep Foundation)
Practicing sleep hygiene will help achieve optimum
sleep:
1.
2.
3.
4.
Avoid caffeine and nicotine close to bedtime.
Avoid alcohol as it can cause sleep disruptions.
Retire and get up at the same time every day.
Exercise regularly, but finish all exercise and
vigorous activity at least 3hours before bedtime.
5. Establish a regular, relaxing bedtime routine (a
warm bath, reading a book.
6. Create a dark, quiet, cool sleep environment.
7. Have a comfortable mattress and bedding.
8. Use the bed for sleep only, do not read, listen to
music, or watch TV in bed.
9. Avoid large meals before bedtime.
Sleep Assessment
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Seep assessment is an important nursing
function. If a client reports snoring, apnea,
restlessness, or insomnia, he or she may have
sleep disorder.
Recommended keeping a sleep log detailing how
many hours are spent in sleep each night and any
problems with sleep.
If insufficient sleep is causing trouble
concentrating or completing daily activities,
recommend consulting a doctor, as a sleep
disorder may be to blame.
Tobacco and Health Risk
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Smoking cessation is an important step in
achieving optimum health.
More than half of the world’s smokers live in 14
countries, the Philippines among them.
-Global Tobacco Survey, 2009
in 2009, among the 10 leading causes of death in
the Philippines, 8 are associated with smoking.
Steps to Quit Smoking (from the American Society)
1. Make the decision to quit.
2. Set a date to quit and choose a plan.
- Mark the date on your calendar
- Tell your Family and Friends about the date
and ask for support
- Rid the environment from all tobacco
products and smoking paraphernalia
- Stock-up on oral substitutes
- Practice saying “No thank you, I don’t
smoke.”
3. Deal with withdrawal through:
-
Avoiding temptation
Changing your habits
4. Staying off of tobacco is a lifelong process
Tobacco Control at the Country-Level (from the
World Health Organization, 2012)
MPOWER STRATEGY:
-
Monitor tobacco use and prevention policies,
Protect people from tobacco smoke,
Offer help to quit tobacco use,
Warm about the dangers of tobacco,
Enforce bans on tobacco advertising, promotion,
and sponsorship, and
Raise taxes on tobacco
R.A. 9211 or the Tobacco Act of 2003
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Prohibited Acts:
- Smoking in public places
- Sale of tobacco products to person
below 18 years old age
- All forms of tobacco advertising in mass
media and regulates other forms of
tobacco promotions.
The law requires a printed warning on cigarette
packages.
Enjoins the Department of Health, together with
other government agencies such as the
Department of Education to carry out a
continuous information program on the harmful
effects of smoking, undertake, a National
Smoking Cessation Program, and establish
smoking withdrawal clinics.
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needs, and to change or cope with the
environment.
Health promotion is not just the responsibility of
the health sector, but goes beyond healthy
lifestyles to well-being.
Three Basic Strategies for Health Promotion
1. Advocacy for health to provide for the conditions
and resources essential for health.
2. Enabling all people to attain their full health
potential; and
3. Mediating among the different sectors of society
in efforts to achieve health -WHO, 1986
Five Priority Action Areas to Support the Basic
Strategies Health Promotion
Alcohol Consumption
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In the Philippines, drinkers had a per capita
consumption of 17 liters, while male drinkers
consuming19 liters and female drinkers, 10.9
liters.
Among students who ever had a drink of alcohol
other than a few sips, the percentage who had
their first drink of alcohol before age 14 years
was 61% among males and 51% among females,
for a combined proportion of 56.7%
- WHO, 2011
Heavy drinking is having more than two drinks
per day on average for men or more than one
drink per day for women.
Binge drinking is drinking five or more drinks
on a single occasion for men or four or more
drinks in a single occasion for women,
Excessive drinking is heavy drink, binge
drinking or both.
Person Who SHOULD NOT Drink (from CDC)
1. Pregnant or trying to be pregnant.
2. Taking prescription
or
over-the-counter
medication that may cause harmful reaction
when mixed with alcohol.
3. Younger than age 21.
4. Recovering from alcoholism or are unable to
control the amount that they drink.
5. Suffering from a medical condition that may be
worsened by alcohol.
6. Driving, planning to drive, or participating in
other activities requiring skill, coordination and
alertness.
1.
2.
3.
4.
5.
Health Education vs Patient Education
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Product of the first International Conference on
Health Promotion held at Ottawa, Canada on
November 17 to 21, 1986.
Organized by the World Health Organization
The charter calls for a commitment for health
promotion to achieve the goal of Health for all
by the year 2000 and beyond.
Defines health promotion as:

The process of enabling people to increase
control over, and to improve their health which
requires that an individual or group must be able
to identify and to realize aspiration to satisfy
Health education is the process of changing
people’s knowledge, skills, and attitudes for
health promotion and risk reduction.
Patient education usually refers to a series of
planned teaching-learning activities designed for
individuals, families or groups with an identified
alteration in health. –Maurer & Smith, 2009
Principles to Guide the Effective Nurse Educator
1.
2.
3.
4.
5.
6.
Message
Format
Environment
Experience
Participation
Evaluation
- from Stanhope & Lancaster, 2010
Requisite Competencies of Barangay Health Workers
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Ottawa Charter for Health Promotion
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Build health public policies.
Create supportive environment.
Strengthen community actions.
Develop personal skill.
Reorient health services.
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Skills
- Communication
- Interpersonal
- Teaching
- Organizational
- Advocacy
Knowledge
- Health issues (communicable and noncommunicable)
- Available community resources
Proper Attitude
Related Trainings