Challenges of Health Promotion

There is a very diverse range of the meaning of health between different groups of people. How a person will define what health means to them will depend on a number of factors. Arguably the most influential of these factors are; age, sex, socio-economic status, social class, location and culture. It is now recognised that there are 5 distinct dimensions of health; physical, emotional, spiritual, social and mental. The World Health Organisation (1948) defined health as ‘as a state of complete physical, mental and social well-being’.

Kelleher (1991) says that for some people being healthy means being happy, for others it may be an expectation of living for a long time, while others may see it as an exclusion of illness. These definitions of health may be influenced by personal experience of illness, however some may see it as simply just being able to cope and go about their daily lives without interference. Generally the most dominant definition of health is merely seen as an absence of illness, often described as a negative definition. Downie et al (1990) say that ‘negative definitions of health can be linked to perceptions of what is abnormal, unwanted or incapacitating’.

Age is a very important factor in determining how someone defines health, as those of a younger age group will mainly focus on the physical aspects of health such as fitness and diet. Generally however, as people age they place more emphasis on the emotional and spiritual aspects of health. This shows that social factors are a very big determinant of how someone will define health. A lot of podiatry work involves working with various people to improve their health for example keeping them mobile and alleviate painful symptoms due to some form of fragility, illness or disability. This may include short term treatments or long term care may be required.

The definition of health has also changed over time, for example the Ancient Greeks believed that illness was caused by an imbalance in the humours (bodily fluids). In contrast in Victorian times, illness was seen as ‘ the will of God’, a more spiritual take on the concept of health.

There are three models relating to the concept of health; the Bio medical model emphasises health in terms of biological processes of the body. In contrast the Social model of health asserts that in addition to physical dimensions of health, other dimensions must be considered including the persons social and economic circumstances. It considered the person as a whole living within a social context (Blaxter 2004). The Bio psychosocial model takes the aspects of the previous two models and combines them. It is the dynamic interaction of biological, psychological, and social influences of health, however it focuses more on the individual rather than the social structures surrounding them.

In the 1800’s and 1900’s the focus was on the provision of a healthy environment which included adequate housing and sanitation and the provision of safe food and water. With developments in medical science the emphasis has shifted to preventative medical services e.g. vaccines, immunisation and encouraging people to make healthy choices. This reflects the shift from communal diseases to lifestyle related diseases e.g. cancer.

There are two approaches to health promotion: a preventative approach and an empowerment approach. Glanz, Rimer & Lewis (2002) assert that ‘the central concern of health education is health behaviour’. This means that people’s lifestyles play a significant role in the development and management of disease and through various measures we can encourage people to make healthy choices. In 1975 Marc Lalonde published a report entitled ‘A New Perspective on the Health of Canadians’ in which he argued there are 4 main causes of illness, namely: Inadequacies in current health services, lifestyle or behavioural factors, environmental pollution and physical characteristics.

The Ottawa Charter (1986) outlines the five principal elements of health promotion as; Conducive public policy, supportive environments, community participation, personal skills and the reorientation of health services to allow people to make well informed, healthy choices. Conducive policy refers to the importance of Government policy in general, and not just in health policy, in promoting health. The second element is the provision of supportive environments. This refers to the importance of having healthy physical environments such as in the home, at school, work and in public places.

The community participation element of health promotion consists of involving communities and special interest groups, e.g. the elderly, women, people with disabilities and travellers, in identifying their own health needs and developing services appropriate to these needs.

The final element of health promotion is the reorientation of health services towards services which are concerned with health promotion, protection and disease prevention. This involves shifting the emphasis in health services to primary health care e.g. providing screening services and health checks within a community.

Ewles and Simnett (1999) list the following activities that could be seen as health promotion practices; Mass media advertising, campaigns on health issues, patient education, self-help groups environmental safety measures, public policy issues, health education about physical health, preventative medical procedures, codes of practice on health issues, health enhancing facilities in local communities, workplace health policies and health and social education for young people in schools. Ewles and Simnett (2003) also identify approaches to health promotion. These all flow from a particular set of aims which hope to be achieved. They emphasise that no one aim or approach to health promotion is right but that it is important for us, as health care workers to consider which is appropriate for us, and relevant to our work. However one of the most important factors is educating people, to allow them to make informed, healthy choices.

The first of approaches is medical or preventitive. The aim of this approach is to gain freedom from medically defined disease and disability e.g. cancer. This could be achieved through screening, immunisation and early detection. This approach has been highly successful but tends to reinforce a negative definition of health.