HEALTH PROMOTION PART 1

DR FAUZIAH MOHD NOR

LEARNING OUTCOMES

At the end of the lecture, the students should be able to:

• Explain the primary health care approach based upon the Alma-Ata
Declaration.
• Illustrate the Common risk factor approach as a holistic approach to resolve
oral health issues.
• Define health promotion
Primary Health care era - 1970s to 1980s
• “Health for All” ; Alma-Ata declaration 1978
• Emphasis on Global Cooperation and peace; adapting
health services to countries and communities
• Equity in health care
• Links b/w healthcare and socioeconomic development
• Intersectoral cooperation in health promotion and disease
prevention
Health Promotion era – 1990s to present
• New Public Health
• Ottawa Charter 1986
• 5 key principles
1) Build healthy public policy
2) Create supportive environments
3) Strengthen community action
4) Develop personal skills
5) Reorient health services
PRIMARY HEALTHCARE APPROACH
• During 1970’s, 80% of all diseases in the developing countries
were diseases that could be prevented (e.g Diarrhea,
tuberculosis, malaria etc).
• Healthcare system of industrialized nations, oriented to curative
dimensions while neglecting prevention and aspects of social
medicine.
• They were too expensive (medicine, medicine apparatus).
• There was lack of specialists who can handle the high-technical
medicine.
• Social determinants of health was ignored in developed
countries.
• Response of the WHO
WHO established the concept of Primary Health Care.

1978 in the first conference of WHO for health in Alma

Ata/Kazakhstan. “Alma Ata Declaration” of 1978;“Health for all”

This concept is heavily concerned with people, especially with the

principles of social justice, accessibility, appropriateness and
acceptance of medical services with consideration of the needs of
people in the communities, their participation and orientation to
the concept of health services.
• In the Declaration of Alma Ata, PHC means that:
“Primary Health Care is based upon practical, scientific, solid and
social acceptance of methods and technology. It is fundamentally
health care that is generally accessible to the individual and families in
the community through their participation and with a cost that the
being of the community life and the country can determine with
sustainability in the spirit of self-confidence and self-determination.
Primary Health Care systems whose main areas of concern are formed
by the community, is dependent upon the general social and economic
development of the country.”
Pillars of Primary Health Care
The concept is carried out through the following pillars. If some elements
are rejected or overemphasized, the concept cannot function well any
more.
1. Social justice: Equal distribution of the available resources.
2. Preventive Health care: Prevention of diseases in the sense of
primary prevention.
3. Participation of the inhabitants: Participation of the intended groups
in planning and carrying out issues related to people’s health,
4. Inter-sector cooperation: Health support outside the medical
services,
5. Technology that marches with the context: favourable or
affordable price and local technology,
6. Sustainability of the measures: Guaranteeing curative services
including services of medicines.

The PHC-strategies led to the reorganization of the health systems in

the developing countries. PHC, RH, DH
• Health is more than medical factors and medical services. Namely it is dependent
upon improvement of life conditions and satisfaction of basic needs.

• Social determinants of health ignored

• https://www.youtube.com/watch?v=8PH4JYfF4Ns

• Health is both an individual and social responsibility that is best secured by

collaborative actions at all levels of society.
 The Ottawa Charter (WHO, 1986) outlined five key areas of
action as:

 Creating supportive environments

 Building healthy public policy
 Strengthening community action
 Developing personal skills
 Reorienting health services
https://www.youtube.com/watch?v=G2quVLcJVBk
 These five strategies have the aim of promoting equity in
health by maximizing everyone’s opportunities to be
healthy and reducing inequality by ensuring that everyone
achieves their health potential.
Health promotion has three important elements:
1) Focus on tackling the determinants of health.
2) Working in partnership with a range of agencies and
sectors.
3) Adopting a strategic approach utilizing a
complementary range of actions to promote the health of
the population.
1. Determinants of health:
• Socio-economic and environmental factors, plus the
individual health – related behavior determinants.

• It therefore attempts to avoid a victim – blaming

approach by recognizing the limited control many
individuals often have over their health.

• A major emphasis in health promotion is therefore to

make the healthy choices, the easy choices by focusing
attention upstream.
2. Working in partnerships:

• Community participation is an essential element of health

promotion.

• The active involvement of the local community in all aspects,

from the identification of the health issue to ways of
initiating change, is a central principle.

• One of the key roles of professionals is therefore in

enabling and nurturing health promotion within communities.
3. Strategic action:
•A strategic approach is required for the development of
effective health promotion policies.
•A strategy should be based on an appropriate assessment of
local needs and resources, which enables the development of a
strategic vision with clearly stated and identified aims and
targets.
• Many health problems share common risk factors; for example,
eating an unhealthy diet which is high in fat and sugars and low
in fiber can lead to the development of obesity, coronary heart
disease, and diabetes, as well as dental caries.
JAKARTA DECLARATION, 1997

WHO Jakarta Declaration, 1997 added:

1. Promote social responsibility for health
2. Increase investment for health development
3. Expand partnership for health promotion
4. Increase community capacity & empower individuals.
5. Secure infrastructure for health promotion
COMMON RISK FACTOR APPROACH (CRFA)

• Oral health problems have risk factor in common with a number of important
chronic diseases, and it’s inefficient to target each disease separately when
they have similar origins.
• By integrating oral health into strategies for promoting general health and by
assessing oral needs in socio-dental ways, health planners can greatly
enhance both general and oral health thus leading to an improvement in
quality of life.
• Many oral health programs are developed and implemented in
isolation from other health programs leads at best to a duplication
of efforts, or worse conflicting messages being delivered to the
public.

• 4 main risk factors are tobacco use, unhealthy diet, physical

inactivity and harmful use of alcohol.

• Common risk factors between general and oral health provide a

rationale for dental health professionals to partner with community
members to develop health promotion programs that will benefit a
multitude of individuals.
DEFINITION OF HEALTH
PROMOTION
‘The process of enabling people to increase
control over and to improve their health’
(WHO, 1984)
PRINCIPLES OF HEALTH
PROMOTION
WHO (1984) outlined a set of principles and priorities for
health promotion:
 Health promotion involves the population as a whole in the
context of their everyday lives rather than focusing on
people who are sick or at risk for specific diseases.
• It is directed towards action on the determinants of health
and requires close cooperation between many different
sectors of society.
• It combines many different approaches and requires
organizational change, community development and local
activities to identify and remove health hazards.