The Need for Health Promotion
Understanding Key Terms/Concepts
• HEALTH: “the state of complete mental,
physical and social well being not merely the
absence of disease or infirmity.” (WHO, 1947)
– Physical: the absence of disease and disability;
functioning adequately from the perspective of
physical and physiological abilities; the biological
integrity of the individual
– Mental: may include emotional health; the subjective
sense of well-being
– Social: the ability to interact effectively with other
people and the social environment; satisfying the
interpersonal relationships; role fulfillment
Understanding Key Terms/Concepts
• COMMUNITY HEALTH: “The health status of a defined
group of people and the actions and conditions to protect
and improve the health of the community” (Green &
McKenzie, in press)
• HEALTH EDUCATION: “any combination of planned
learning experiences based on sound theories that
provide individuals, groups and communities the
opportunity to acquire information and the skills needed
to make quality health decisions (Joint Committee, 2001)
• HEALTH PROMOTION: “any planned combination of
educational, political, environmental, regulatory, or
organizational mechanisms that support actions and
conditions of living conducive to the health of individuals,
groups, and communities (Joint Committee, 2001)
Relationship between Health
Education and Health Promotion
HEALTH PROMOTION
Environmental
Organizational
Regulatory
Environmental
Environmental
Health
Education
Policy
Social
Environmental
Environmental
Political
Economic
Environmental
HEALTH PROMOTION
Understanding Key Terms/Concepts
• DISEASE PREVENTON: “The process of
reducing risks and alleviating disease to
promote, preserve, and restore health and
minimize suffering and distress” (Joint Committee,
2001)
• PUBLIC HEALTH: “The sum of all official
(governmental) efforts to promote, protect, and
preserve the people’s health” (McKenzie et al., 1995)
• WELLNESS: “an approach to health that
focuses on balancing the many aspects, or
dimensions, of a person’s life through increasing
the adoption of health-enhancing conditions and
behaviors rather than attempting to minimize
conditions of illness” (Joint Committee, 2001)
Understanding Key Terms/Concepts
• PREVENTION: the planning for and the
measures taken to forestall the onset of, a
disease or other health problem before the
occurrence of undesirable health events”
(Cottrell et al., 2000)
– Primary prevention:
– Secondary prevention:
– Tertiary prevention:
Levels of Prevention
Health Status
Levels of Prevention
Healthy; without signs and
symptoms of disease, illness,
or injury
Primary prevention – preventive measures
that forestall the onset of illness or injury
during the prepathogeneisis period
Disease, illness,
or injury
Secondary prevention – preventive measures
that lead to early diagnosis and prompt
treatment of a disease, illness, or an injury to
limit disability, impairment, or dependency
and prevent more severe pathogenesis
Disability, impairment
or dependency
Tertiary prevention – preventive measures
aimed at rehabilitation following significant
pathogenesis
Death
Levels of Prevention
• Examples of Primary prevention:
– Wearing a safety belt, using rubber gloves when there
is potential for the spread of disease, immunizing
against specific diseases, exercising
• Examples of Secondary prevention:
– Personal and clinical screenings and examines such
as blood pressure, cholesterol, hemocult (hidden
blood) screenings; breast self-examines, testicle selfexams
• Examples of Tertiary prevention:
– Educating a patient after lung cancer surgery, working
with an person who has diabetes to ensure that the
daily insulin injections are taken
WHY HEALTH PROMOTION?
• History
– Public health revolution in the U.S. started in
the late nineteenth century, aimed at
controlling for the harm (morbidity and
mortality) that came from infectious diseases.
• By the mid-50’s infectious diseases were under
control
• Reduced # children who were contracting
childhood diseases, death rates, and increased life
expectancy
Rate per 100,000 population
Infectious and Chronic Disease
Death Rates in the United States,
1990-2000
Infecitous disease
Chronic diseases
1500
1400
1300
1200
1100
1000
900
800
700
600
500
400
300
200
100
0
1900
1920
1940
1960
Year
Source: Armstrong et al., (1999, JAMA)
1980
2000
Life Expectancy at Birth
Past and projected female and male
life expectancy at birth, United
States, 1900–2050.
* Death registration area only. The death registration area increased
from 10 states and the District of Columbia in 1900 to the entire
United States in 1933.
Source: U.S. Department of Commerce, Bureau of the Census.
WHY HEALTH PROMOTION?
• Process check
– By the mid-70s, the greatest potential for
reducing morbidity, saving lives, and reducing
health care costs in America was to be
achieved through health promotion and
disease prevention
– At the core of this approach was health
education.
WHY HEALTH PROMOTION?
• Major epidemic diseases, however, remain
threats to public health
– e.g., heart disease, cancer,
overweight/obesity, diabetes, etc.
• Costs, both direct and indirect, related to
health care, such as delivery and
insurance, have risen steadily
WHY HEALTH PROMOTION?
• Heart Disease
– Morbidity: Number of noninstitutionalized adults with
diagnosed heart disease: 23.0 million (2002); Percent
of noninstitutionalized adults with diagnosed heart
disease: 11.2 (2002) (CDC, 2005)
– Mortality: Number of deaths: 696,947 (2002);
Deaths per 100,000 population: 241.7 (2002);
Cause of death rank: 1 (2002); % of hospital
inpatient deaths from heart disease: 21.0 (2000)
WHY HEALTH PROMOTION?
• Cancer
– Morbidity: % of noninstitutionalized adults
who have ever been diagnosed with
cancer: 7.0 (2002)
– Mortality: Number of deaths: 557,271
(2002); Deaths per 100,000 population:
193.2 (2002); Cause of death rank: 2 (2002)
WHY HEALTH PROMOTION?
• Overweight (BMI 25-29.9) and obesity (BMI of 30 or
greater)
– An estimated 30 percent of U.S. adults aged 20 years and older over 60 million people - are obese.
– An estimated 65 percent of U.S. adults aged 20 years and older
are either overweight or obese (a BMI of 25 or higher).
• Health Consequences: Hypertension; Dyslipidemia
(e.g., high total cholesterol or high levels of triglycerides);
Type 2 diabetes; Coronary heart disease; Stroke;
Gallbladder disease; Osteoarthritis; Sleep apnea and
respiratory problems; Some cancers (endometrial,
breast, and colon)
WHY HEALTH PROMOTION?
• Economic Consequences
– Overweight and obesity and their associated health problems
have substantial economic consequences for the U.S. health
care system. The increasing prevalence of overweight and
obesity is associated with both direct and indirect costs. Direct
health care costs refer to preventive, diagnostic, and treatment
services related to overweight and obesity (for example,
physician visits and hospital and nursing home care). Indirect
costs refer to the value of wages lost by people unable to work
because of illness or disability, as well as the value of future
earnings lost by premature death (The Surgeon General's Call
To Action To Prevent and Decrease Overweight and Obesity,
2001).
– In 1995, the total (direct and indirect) costs attributable to obesity
amounted to an estimated $99 billion. In 2000, the total cost of
obesity was estimated to be $117 billion ($61 billion direct and
$56 billion indirect). Most of the cost associated with obesity is
due to type 2 diabetes, coronary heart disease, and
hypertension.
WHY HEALTH PROMOTION?
• Diabetes
– Morbidity: Number of noninstitutionalized
adults with diagnosed diabetes: 13.4 million
(2002); % of noninstitutionalized adults with
diagnosed diabetes: 6.6 (2002)
– Mortality: Number of deaths: 73,249
(2002); Deaths per 100,000 population: 25.4
(2002); Cause of death rank: 6 (2002)
The Current State of Public Health In China
• Past 50 yrs, achievements in controlling
infectious diseases and improving the
public’s health and hygiene
• In the 21st century, owing to the negative
effects brought on by aging of the
population and the burdens of diseases,
urbanization, industrialization, and
globalization, China is encountering
greater difficulties than ever
Liming Lee, Annu. Rev. public Health 2004, 25:327-39
The Current State of Public Health In China
Problems:
• poor capacity to respond to public health
emergencies
• Severe inequality of health care services
• lagging development of public health
information systems
Needs
• build a public health information system
• interventional exchange (globalization)
• high technology
• health education and health consultation
Increasing Awareness
• Although a great deal of progress has been
made in public health, there is still a need for
health promotion activities to improve the health
and reduce costs.
• Healthy People 2010
– 467 objectives in 28 focus areas, making this
blueprint an encyclopedic compilation of health
improvement opportunities for the next decade.
– 2 Goals, reflecting the Nation’s changing
demographics
• Goal 1: Increase Quality and Years of Healthy Life
• Goal 2: Eliminate Health Disparities
Note: http://www.healthypeople.gov/Publications/
Increasing Awareness
• Healthy People 2010
• Proposing a multiple level approach to reduce
health risks and increase chances for good health
• Setting a set of health goals and objectives for the
nation
• emphasizing the merit of developing and
implementing strong, results-oriented health
promotion programs that address public health
issues.
Note: http://www.healthypeople.gov/Publications/
Impetus
• The focus on good health has given many
people, agencies, organizations, communities,
and workplaces in the U.S. a desire to do
something about their health
• This desire, in turn, has created a greater need
for good health information that can be easily
understood by the general community
• Because of the increased interest in health,
health professionals are now faced with
providing the public with the information and the
skills needed to make quality health decisions.