Health Promotion
Defining and conceptualising
Using models
Case studies
Session outcomes
1. The explain the roots of health promotion
2. To apply three different frameworks(models
or typologies) that explain the scope of
health promotion to different contemporary
topics.
3. To explain selected principles of health
promotion practice to a case study
The roots of health promotion
• Health Promotion emerged from health
education movement.
• Health education noticeable in early 1900s with
emphasis on cleanliness, personal behaviour and
therefore responsibility for ones own ill-health
and health.
• The Central Council for Health Education was
founded in 1927.
• This explains why health education is often
viewed as the main
What is Health Promotion?
• Today Health Promotion is more than personal and
population education.
Defined in a number of ways
“The process of enabling people to increase control over and
improve their health”
(World Health Organisation 1986)
Health Promotion = health education x healthy public policy.
(Tones and Tilford, 1994)
The scope of health promotion activity
• Frameworks and Models are tools that help explain
phenomena.
• Many tools developed to explain the scope of health
promotion.
Tannahill, (1985) model of health promotion
Naidoo and Wills (2000) typology of health promotion
Beattie’s (1991) model of health promotion
Tones and Tilford’s (1994) empowerment model of
health promotion
Caplan and Holland’s (1990) Four perspectives on
health promotion
Beattie’s model of Health Promotion
Authoritative
Legislative
Action
Focus
Act
Resources
Policy
Health persuasion
Needs to focus on
why behaviour is
happening
Individual
Collective
Community
Development
Empowerment
community level
Skills
Personal Counselling
Greater control
Negotiated
Beattie’s model applied
Key features
• Examines 2 axis i) type of approach used top down
(authoritarian) or bottom up (negotiated or owned by
clients) ii) size of approach
• Categorises 4 types of activities
a) Personal Counselling eg working with dietician on food
and physical individual personal plans and goals
b) Health persuasion eg Campaign of eating 5 fruit and
vegetables a day on TV
c) Legislative action eg laws that subsidise the price of
healthy food stuff
d) Community development eg communities producing and
distributing food themselves
Lobbying,
Advocacy &
mediation
Coalitions
Healthy Public Policy
Public
Pressure
Social, Economic and
Environmental Influences
HEALTH
Reframe &
reorient
health
services
Community
Empowerment
Individual empowerment
Critical
consciousness
raising
A. S.
HEALTH EDUCATION
An Empowerment Model
(adapted from Tones & Tilford 2001)
Tones and Tilford’s (1994) model of
health promotion
Key features
• States interaction between two main sets of processes
for health improvement i)development and
implementation of healthy public policy ii) health
education in which people are empowered to take
control of their life.
• Example is attempts of Jamie’s School Diners campaign
where school meals was brought into public
consciousness and lead to standards for meals and an
increase in the budgets for school meals.
• Only when these two approaches work in parallel can
the conditions for living and individuals behavioural
aspects of health be addressed
Caplan and Holland’s model of health
promotion (1990)
Radical change
Radical Humanist
Subjective
Nature of society
Radical structuralist
Objective
Nature of knowledge
Humanist
Social regulation
Traditional
Caplan and Holland’s model of health
promotion (1990)
Key features
More complex and theoretically driven
Attempts to unpick what determines health and illhealth and therefore what activities can be used to
address health issues.
One axis refers to a theory of knowledge and how
knowledge is generated in relation to health
The other axis refers to how society is constructed and
how this impacts on health.
Application to domestic violence
Nature of society
Radical Humanist
Provide supportive networks and self help groups
and use of safe houses to remove women from
violence.
Women to gain more power by developing
economic and social power via work and stronger
networks.
Radical structuralist
Working to reduce power inequality between men
and women through legislation for gender
equality.
Issue to be taken seriously by criminal justice
system .
Social unacceptability of issue generated through
advocacy and lobbying.
Nature of knowledge
Humanist
Working with women (and men) directly so they
can understand the nature of their experiences
and what they can do themselves. Using
cognitive-behavioural therapy (CBT)
approaches to understand the issues and
change behaviour.
Traditional
Treatment of injuries
Educational campaigns about the issue to raise
awareness and change attitudes to domestic
violence in populations.
Key principles in health promotion
• Principles are important as they relate to how
we should work in practice.
• The World Health Organisation provides a
global perspectives
• Gregg and O’Hara (2007) provide a good
synthesis of many of these
Focus on upstream approaches
• “You know”, he said, “...sometimes it feels like this. There I
am standing by the shore of a swiftly flowing river and I
hear the cry of a drowning man. So I jump into the river,
put my arms around him, pull him to shore and apply
artificial respiration. Just when he begins to breathe, there
is another cry for help. So I jump into the river, reach him,
pull him to shore, apply artificial respiration, and then just
as he begins to breathe, another cry for help. So back in the
river again, reaching, pulling, applying, breathing and then
another yell. Again and again, without end, goes the
sequence. You know, I am so busy jumping in, pulling them
to shore, applying artificial respiration, that I have no time
to see who the hell is upstream pushing them all in”
(McKinlay, 1979 p 249).
Non- victim blaming approaches
• Victim blaming is an approach to health education
which only focuses on individual action rather than the
external forces that influence an individual person
resulting in blaming people for their health behaviour
and related consequences (Hubley and Copeman,
2008).
• Practitioners should resist victim-blaming as it does not
show understanding of the influences of health
behaviour.
• Instead practitioners should consider the social and
economic experiences of people’s lives and which may
explain how & why people behave in the manner that
they do.
Evidence based practice
• Evidence based practice is concerned with trying
to understand which approaches and methods of
working are likely to produce the strongest health
improvement.
• The principle of generating evidence by providing
stronger evaluation of programmes and initiatives
as they are developed & implemented and
encouraging the utilisation of the existing
evidence base by practitioners, are both key
principles of practice.
Participation and empowerment
• Participation implies ‘being present and taking part’ in
health promotion activities and secondly recognising
that when people participate what they say should be
listened to and acted upon (Lowcock and Cross, 2011).
• Empowerment is an approach that facilitates people
working together to increase the control that they have
over events that influence their lives and health
(Woodall et al. 2010)
• Given that a definition of health promotion is about
taking control then these two interlinked concepts are
fundamental to how we act as practitioners
Equity
• Equity in health is concerned with fairness and the idea
that everyone should have equal right to the fullest health
possible.
• The term inequity enshrines an unfair distribution of health
status. Eg poorer health is experienced in lower social
classes
• Health should be more equally distributed and that health
promotion approaches should, as a high priority, address
health inequities.
• Policies and projects are now being evaluated to assess
their impact on health equity, to reduce the disproportional
impact on those that already experience poorer health,
using a technique known as health equity audits (Health
Development Agency, 2003)
Ethical principles
• There are four major ethical principles outlined in
Naidoo and Wills, 2009
• Autonomy – “Respect for the rights of individuals
and their rights to govern their own lives”
(Naidoo and Wills, 2000 p91)
• Beneficence - Doing and promoting good but we
would need to consider whose good, the
individual or wider group
• Non-maleficence - Doing no harm
• Justice - People should be treated equally and
fairly.
Summary
• The scope of health promotion is varied and
diverse and not limited to health education.
• In order to address health issues a wider
range of health promotion approaches should
be used that directly address the wider
upstream determinants.
• Approaches should be evaluated on the basis
of key health promotion principles.