What is Health Promotion?
Health promotion is the process of enabling people to improve their health, by increasing their control over their health and the determinants of good health. It is essentially the effort to prevent disease and injury from occurring in the first place, as opposed to traditional health services, which treat disease and injury once it has occurred.
Unlike the traditional clinical care provided by health services, health promotion focuses on populations (or communities), as opposed to individuals. Often, health promotion requires the health system to work with non-health sectors, such as schools, child care, workplaces, local government, as they have a powerful influence over health.
Emphasis on providing the right information to the patient can reduce the chances of developing chronic illnesses such as heart disease, cancer and Type II diabetes. By making just a few small but important lifestyle changes, people can ensure better health and wellbeing for the future - and more time to enjoy the important things such as spending time with friends and family.
In Australia focusing on the state of NSW, the state government has written the State Plan which defines some of the key priorities for health promotion, this being improved health through reduced obesity, smoking, illicit drug use and risk drinking.
The following targets have been set for these priorities:
• Continue to reduce smoking rates by 1% per annum to 2010, then by 0.5% per annum to 2016.
• Reduce total risk (binge) drinking to below 25% by 2012
• Hold the proportion of people using illicit drugs to below 155
• Stop the growth in childhood obesity by holding childhood obesity at the 2004 level of 25% by 2010. Then reduce levels to 22% by 2016.
Health Promotion Aims:
Health promotion priorities are also described in the State Health Plan and Healthy People NSW. The State Health Plan is the NSW Government’s long term plan to deliver the best possible health care services to the people of NSW towards 2010 and beyond. It sets strong targets for better health service delivery across the public sector in NSW. The priorities in the State Plan are a result of extensive consultation with the community, business and stakeholder groups. More than 3,500 groups and individuals provided their views and local knowledge in the development of this Plan. Each local region in NSW, known as the Area Health Service, responds to the local priorities that were raised during the community consultations.
Organizational Partnerships in Health Promotion:
The types of organisations involved are the NSW Health Department and the Centre for Health Advancement within the Population Health Division. These organisations, address the main at risk groups and leads the health promotion activities to address smoking, overweight and obesity, and falls prevention in the elderly. From time to time the Centre also works on emerging issues, such as diabetes prevention, sun protection and child injury. For example:
Healthy People NSW:
Improving the health of the population sets the platform for population health action in NSW over the next 5 years and beyond. The plan builds on existing population health efforts in NSW, including Healthy People 2005, and identifies key issues that must be tackled to meet the challenges arising from the changing profile of our community, increasing prevalence of chronic conditions and the persistent threat of existing, novel and re-emergent infectious diseases.
Live Life Well is another awareness program to communities. Australians are living longer than ever before. To ensure people get the most out of life, it is important they look after themselves to remain healthy and happy for as long as possible. The overarching theme of the program is, to Live Life Well and to take positive steps to maximise your chances of living an illness free life.
A promotional website offers the public basic information and tools that will enable them to start making healthier changes to Live Life Well including quit smoking, eating better, being active, limiting your alcohol, maintaining a healthy weight, and managing stress.
Enhanced Primary Care Program: Health systems around the world have traditionally treated sick people, and now greater emphasis is placed on prevention. In 2004 the Federal Government introduced an incentive scheme for General Practitioners to refer their patients with chronic health disease to Allied Health Professions to provide a total care plan for their patient, called the Enhanced Primary Care Program . 11 Allied Health professions can be involved as part of the care plan. Some patients require up 2-3 professional consults dependent upon their underlying health issues, such as diabetes. For this patient a consult with the Diabetes Educator is important, as well as to the Dietician, Podiatrist and Eye Specialist.
Strict guidelines are in place as to who is eligible to receive assessments and treatments from the appropriate professional. Assessment and treatment is provided accordingly, but the consult is also an opportunity for the practitioner to educate their patient about their underlying health issues and empower them with greater knowledge to enable them to take charge of their health care program.
This greater knowledge often allay fears of horror stories they have heard about older family members, such as grandparents, who may have fallen victim to complications from infections resulting in amputations of the lower limb. As part of the intervention process professionals integrate a treatment plan. This process is in consultation between the practitioner and patient and reviews take place every 3 or 6 months and then annually, to monitor changes and hopefully overall improvement in their health status.
Between the years of 2004-2008, 1.3 million consults for Podiatrists alone were registered at the cost of 62 million dollars. The uptake of this program has significantly increased within the past 18 months, as more Doctors implement the program with their elderly patients with chronic disease. The long term benefits will still need to be seen, as the return of investment on such programs cannot be appreciated in the short term. As with most countries around the world the health care budget is a burden on any government, and as the population continues to age, more people living longer, it is known that this will place a strain on the current system. Ref: Burns, Josh 2009
Happy Healthy Harold is a NSW State Government funded initiative in partnership with NSW Department of Education and Training (DET NSW) to cater to all schools K-12 the importance of health & wellbeing. The mobile unit visited all schools across the state to promote awareness of drug and alcohol, obesity and the importance of exercise, dental care, sexual education and hygiene including transmittable disease. Issues such as the importance of good handwashing techniques, youth at risk of alcohol and drug abuse, anger management and child abuse. Safety Houses and Neighbourhoods were promoted through recognised symbols and signage on the streets to help the first steps of intervention to dysfunctional families.
Evidence Based Health Promotion
One of the basic concept models of interventions in Australia is evidence-based practice. Basically the movement to develop 'evidence based practice' first began in the field of medicine and has now spread to all parts of the health sector and other public sector activities. It is now widely accepted that activities to improve health should be supported by sound evidence.
This particular model works at the most basic level where evidence involves 'the available body of facts or information indicating whether a belief or proposition is true or valid'. Evidence based public health and policy is an exercise in constructing realities and interventions within particular contexts. This is particularly good for policy-decision makers, whereby, evidence may be defined as 'anything that establishes a fact or gives reason for believing something'.
Evidence-based health promotion refers to the development, implementation, and evaluation of effective programs and policies in population health through application of evidence, including systematic appraisal of research and appropriate use of program planning models. From this perspective, health promotion practice is directly linked with evidence that demonstrates effectiveness.
Effective, high quality health promotion policy and practice depends on the availability of information from existing research and evaluation, statistical sources and expert knowledge. Evidence based practice relies on the findings of sound evaluation research to determine whether an intervention is likely to be effective. The following organisations are involved with the assessment and delivery of the effectiveness of health promotion and population health interventions.
1. Area Health Services and Community Based Hospitals and Health Centres
2. Allied Health Professional Associations, eg. Australian Podiatry Association (NSW), Diabetes Australia
3. Royal Flying Doctor Service
4. Divisions of General Practice
5. The Cochrane Collaboration. Preparing, maintaining and promoting the accessibility of systematic reviews of the effects of health care and population health interventions.
Examples of NSW organisational integration within the community to implement an intervention process are as follows:
1. Flood Cleanup Guidelines, Including Information on Mosquitoes
A natural disaster declaration covering a number of Local Government Areas (LGA) within Greater Western Area Health Service (Broken Hill) has been made due to the recent flooding from the Queensland cyclones in January /February 2010. The LGAs include: Broken Hill, Bourke, Brewarrina, Coonamble, Gilgandra, Walgett, Warrumbungle and Warren.
• Cleaning rainwater tanks inundated with floodwater
• Fact sheet procedure for restoring flood water inundated domestic swimming pools
• Food safety and vegetable gardens following floods
• Flood clean up guidelines
• Mosquitoes are a health hazard fact sheet
• Mental health support available
2. Greater Western AHS Chief Executive urged the community to take up free swine flu vaccine.
A proactive approach was taken by the Australian Federal Government prior to the Winter season of 2009, to provide free swine flu vaccines to all health professionals, as well as carers of sick and the elderly people.
The preventative measure was to offer the swine flu vaccine in response to the high incident outbreak in the Northern Hemisphere Winter outbreak. Previous winter flu season and reports indicated that H1N1 pandemic activity was high in Europe, the Middle East, Asia and North America with the transient population around the world potentially spreading the disease as they return home. People in the at risk group included: people with underlying chronic medical conditions, heart and lung disease, cancers, HIV, asthma, diabetes; people who are morbidly obese; Indigenous people and pregnant women.
During the initial stages of the rollout, the focus was on ensuring that people in at risk groups were offered the vaccine first. Vaccination was not restricted to this group but was available to anyone who wished to be vaccinated. The aim of the program was to provide free vaccination against pandemic (H1N1) 2009 influenza for all members of the community who wished to be vaccinated.
Vaccinations started on the 30 September 2009. The World Health Organisation, in collaboration with the national and state bodies, monitored the safety of the pandemic vaccine. Worldwide, millions of doses had been distributed and administered. Safety data suggested that the vaccine had no more side effects than that seen with seasonal influenza vaccine. Promotional material encouraged parents to protect their children against swine flu, with the vaccine available for all children aged 6 months and over. It also advised the importance to have an infant less than 6 months of age in your care vaccinated.
The Australian Government's Chief Medical Officer indicated that while two doses of vaccine for children less than 10 years is recommended, one dose may still provide a good level of protection against pandemic influenza. General Practitioners and Aboriginal Medical Services have been administering vaccinations to the community. Over 73,000 doses of vaccine have been distributed in Greater Western AHS. People can access the following website for more information on H1N1 Influenza, through the NSW Health Pandemic Vaccination link at http://www.emergency.health.nsw.gov.au/swineflu/
3. Free Child Weight Management Program for local families
As obesity is becoming an increasingly important issue in our local community with almost 25% of Australian children currently overweight or obese promotional programs have been developed. The current trends indicate that by 2050 the incidence of child obesity will be closer to 50%. Based on this prognosis the NSW Parenting Program took the intervention communication strategy “What is it and who is it for?” implementing MEND (Mind, Exercise, Nutrition…Do it!). This is part of a national initiative offering free healthy lifestyle courses for children 7- 13yrs old who may not fit within the ideal weight range and their families.
4. The NSW Collaborative Centre for Aboriginal Health Promotion
The philosophy and underlying principles of the NSW Collaborative Centre. The NSW Collaborative Centre for Aboriginal Health Promotion is a joint initiative of NSW Health and the AH&MRC. The Centre is a major step forward in developing better practice health promotion approaches to improve Aboriginal health in NSW. The philosophy of the NSW Collaborative Centre for Aboriginal Health Promotion (CCAHP) is to improve the effectiveness of Aboriginal Health Promotion in NSW and throughout Australia. The Centre will ensure a strategic approach for Aboriginal health promotion as well as fostering leadership for Aboriginal health promotion at the NSW state level. The Centre will seek to achieve these goals through three key functions:
- Gathering, reviewing and disseminating case studies of good practice in Aboriginal health promotion via a clearinghouse/website function that could be used nationally.
- Providing training opportunities for the Aboriginal health promotion workforce to acquire necessary skills and knowledge in health promotion.
- Increasing the skills of Aboriginal health personnel within local aboriginal Community Controlled Health Services and other local aboriginal community organisations for effective health promotion planning and implementation resourced by the NSW Aboriginal health promotion grants scheme.
5. Cervical Cancer Health Promotion Program for Indigenous Women
According to the recent National Health & Medical Research Council (NHMRC) cervical cancer is now an uncommon disease in Australia, and that mortality from the disease is one of the lowest in the developed world bettered only by Finland. However, this is only good news if you are one of the majority of Australian women who is not of Aboriginal or Torres Strait Islander origin.
Whilst it is important that women understand the meaning of an abnormal result, and that the need for colposcopy and possible travel to a distant centre for treatment in the event of an abnormality being detected, is explained clearly and in appropriate language to women before they consent to screening it is not however, always easy to explain this to the Indigenous female community. In addition the association between vaginal examinations and the diagnosis and treatment of sexually-transmitted infections such as syphilis is another reason why some indigenous women are fearful about cervical screening. Again, more education and information, appropriately and respectfully provided, is essential. It has been observed by many health workers that indigenous women in particular prefer internal examinations and Pap smears to be performed by another woman, hence the real effort that has gone into providing such services and training in Australia especially with the introduction of the Nurse practitioner and Aboriginal Health Worker. It has been suggested that indigenous women health workers might be trained to perform cervical screening and in North Queensland, NSW and WA many have undergone such training. However it has been reported that many women in smaller communities prefer intimate examinations done by women from outside the community, and therefore the value of such health worker training may lie more in educating their communities than in the actual provision of services. It would seem that the provision of more information about the reasons for performing Pap smears, and the consequences, both positive and negative, of screening programs, is pivotal to increasing the participation rates amongst indigenous women especially in QLD where incidences of cervical cancer mortality rate amongst indigenous women is now 10 times greater than the average national rate across Australia.
Indigenous people learn collaboratively and are very audio-visual communicators. They are traditionally educated by the elders through collaborative storytelling and image/pictures using dot- style art paintings. Currently, Central Australian Health Workers are using paintings by Margaret Lankin to represent important health and wellbeing document regarding cervical cancer and sexual diseases as one form of strategy to educate the local indigenous women. The painting tells a story about how important it is for women to have regular Well Women's checks. The traditional women supported each other and traditionally, older women taught the younger ones how to look after themselves and their country. Hence, the shapes in the painting represent the women sitting around together having a meeting. The one with the white dots is the lady from the screening place, who has come to talk about breast screening, cervical cancer and Well Women's screening. The circle with yellow, grey and brown dots is the screening place. Circles with white dots are the other communities involved in this big meeting. The footprints with white dots belong to the lady with all the knowledge she's going to pass on to the Aboriginal ladies there. The two ladies sitting in the circles are shamed. They sit there and wait to hear from the other ladies. The footprints with the yellow dots are the ladies who understand now what breast screening, cervical cancer and pap smears are, and how important it is to be screened. The yellow and white dots scattered over the painting are sending a strong message across to all women to be screened every two years. Read more...
double click on image to view
• Happy Healthy Harold http://www.healthyharold.org.au/
• NSW State Health Plan 2007- A new direction for NSW Report 1/2/2007 /NSW Strategic State Plan http://more.nsw.gov.au/stateplan
• Healthy People NSW: Improving the health of the population
• File link: Healthy People NSW: Improving the health of the population http://www.health.nsw.gov.au/pubs/2007/healthy_people.html 12/2/2010
• Live Life Well http://www.livelifewell.nsw.gov.au/
• NSW Aboriginal health promotion Link 14/2/2010: http://www.ahmrc.org.au/The%20NSW%20Collaborative%20Centre%20for%20Aboriginal%20Health%20Promotion.htm
• NSW Health Promotion evidence in Public Health Link 12/2/2009 http://www.health.nsw.gov.au/publichealth/healthpromotion/evidence/index.asp