In the past years there has been an increasing expectation of new strategies and ideas concerning Public Health and Health Promotion with regards to effectiveness, efficiency and the importance of a wide range of various disciplines contributing to enhance the uses of resources and the practice of health promotion (Macdonald and Bunton 2004).
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This assignment will explore with critical reflections and throw more light on the importance of the various disciplines such as psychology, sociology, economics and ethics that contribute to improve the practice of health promotion. Discussions will include the relevance of economics, sociology and ethics to the practice of health promotion and ways in which these can contribute to understanding and evaluating health promotion. Finally it is expected that this assignment will highlight the problems and challenges identified, address them and make recommendations for professional practice.
CONCEPT OF HEALTH
The most acceptable known definition of health, states that “health is a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity” (WHO 1946). “However, although this definition has been accepted widely as a holistic and positive interpretation of health, it has been criticised for not including the spiritual and emotional aspects of health” (Ewles and Simnett 2003 cited in Bennett et al 2009 p. 48).
The question is what really informs the understanding of health and ill health considering the lay people and the practitioner is that, the definition of health is entirely personal to the individual and his/her life styles. This has become necessary that healthcare professional should understand that the interpretation of health is highly understood differently from one person to the other with regards to issues militating against them from one point of time such as self-esteem, social support, individual control and social status (Laverack 2007), so that in an attempt to address these issues one should be ready to consider to embrace and undertake interventions of health promotions to achieve realistic goals.
Blaxter (1990) identified five main concepts of health as follows, health as a physical fitness, health as social relationships, health as a function, health as psychosocial well-being, that prevails with young men of higher socioeconomic groups and lastly, health as not ill” that is the absence of symptoms or medical effort widely used by all group.
The term health promotion describes a multidimensional approach to encouraging health related lifestyle changes among individuals and communities (Laverack 2007). Health promotion aims to allow people to increase their control over their health and the factors that affect it, with the ultimate aim of enhancing health and its determinants (WHO 1986, 2005).
Naidoo and Wills (2000) described three levels of health education as follows, Primary prevention for example immunisation, Secondary prevention for example screening. Then Tertiary prevention which aims to limit complications associated with irreversible conditions, for example cardiac rehabilitation. However, an individual’s approach to health promotion will be influenced by their own health beliefs and that of the profession they represent. Ewles and Simnett (2003) outlined a framework of five approaches that demonstrate a range of values and beliefs that are commonly held. A value is an idea or concept that is regarded as worthy, desirable or useful (Moore 2001). And according to Fishbein (1976), a belief is a probability judgement that links some object or concept to some attribute
The five approaches are; “Medical approach to prevent disease, Behaviour change approach that is persuasive education, Educational approach that provides patient’s right to make an informed choice, Empowerment approach, this is patient-centred approach that helps patients to identify their own learning needs and, facilitated by a health educator, gain the knowledge and skills they require to make decisions about their health needs and the Social change approach this does not focus on the individual but on society as a whole (Ewles and Simnett 2003). Similarly health promotion interventions can be achieve by adopting the downstream approaches to tackle health behaviours that give rise to problems and upstream approaches to tackle the causes of such behaviours such as alcohol and smoking problem that leads to social exclusion and poverty. To alleviate this problem taxes should be imposed on such items and local employment programmes set up at the upstream to tackle the cause. Health information and behaviour programmes should be provided to solve this problem at the downstream (Mckinlay 1979).
For health promotion to be effective and efficient, it is important to explore a variety of disciplines as well as the use of an available resources and the appropriate evidence base practice (Macdonald and Bunton 2004). The question is which discipline ideas, concepts or theories inform us in promoting health? But generally it has been said that psychology has played an important role in formulating strategies (Bennett and Murphy 1997; Bennett et al. 1995), identifying aims and objectives and suggesting effective approaches for health promotion (Bunton et al. 1991; Bennett and Murphy 1997).
Psychology therefore is concerned with the scientific study of the processes of the mind and behaviour and how human and other animals relate to one another with the environment (Colman 1988). It has been found that psychological theories by using communication model of behavioural change has proved successful and reported of positive outcomes for example, according to Boots and Midford (1999), suggested that females were used in campaigning in mass media activities to raised awareness of drivers to stop drinking when driving in Australia. Similarly Petty and Cacioppo (1986) by the use of Elaboration Likelihood Model explained how pre-existing beliefs and interest of an individual as well as the message content (how it is package) has a positive impact in changing behaviour that is the likelihood of a known HIV positive person who is involve in a campaign of promoting National AIDS awareness programmes can effect an increase knowledge, less risky attitudes and a safer behaviour change than somebody without the disease (Scollay et al. 1992).
It has also been found that the use of the health belief model has given an in-depth understanding about low rates of compliance to screening and prevention recommendations. This type consist of five models, more common are the approaches that increase the barriers to unhealthy behaviours that is by use of increasing taxation in tobacco or alcohol that serves as an effective deterrent with young adults who are more affected by price changes than older adults (Lewit et al. 1981). But Brownson et al. (1995) also affirmed that by imposing restrictions on such items on alcohol without licencing, renders it ineffective that poses political issues and controversy. Also through Social learning theory (SLT), that states behaviour is the product of a relationship between perception and environmental events (Bandura 1997). It has been realised that, behaviours are influenced by two sets of expectancies, the first being the action-outcome that explains the fact that if an individual believes that a particular action will cause disastrous health problems like smoking causes cancer then the individual sees the outcome as a value.
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The second being the self-efficacy expectancy, that is if the individual realises that giving up of smoking will reduce the risk of getting cancer then the person places a high value on the behavioural change. These two expectancy beliefs have been found to be effective in helping to resist peer pressure to smoke or the use of drugs (Stacy et al. 1992) and engaging in safer sex practices (O’Leary et al. 1992). However it has been argued that behaviour comes as a result of a formal decision making and seems to be habitual and ‘thoughtless’ (Hunt and Martin 1988).
Conversely economics as a discipline has also contributed to health promotion either in a positive or negative way globally. Health economics according to Santerre and Neun (2009) “studies the supply and demand of health care resources and the impact of health care resources on a population” (p.4). It can also be used to access the impact of tax changes on smoking behaviour, for instance increasing taxes on such item like cigarette would be very effective. Because it will increase the cost of cigarette which will in turn correspond to a reduction in the number of young adult smokers and at the same time reduce the amount of consumption. Similarly the changes in tax do not actually affect the number of adult smokers. On the other hand if taxes are imposed on cigarettes, the disadvantage is that tobacco duty is going to go up which will affect the poor more the rich (Grossman and chaloupka 1997).
Economic policies has also threaten the developments of interventions globally for instance, the Millennium Development Goals (MDG) which was hailed as a new frame work for development that would have propelled and directed change in the spheres of hunger, health and human right, equality and education is being threaten by economic problems of soaring commodity prices, government decisions of misdirecting funds and global slowdown to bring it to reality. For example this will affect the UN population fund, whose agency focuses on maternal and reproductive health which is a major public health issue for instance it has been estimated that, in India the number of women dying during childbirth is highest anywhere in the world that is one woman dying every three to six minutes from preventable causes, yet the country spends less than 0.9% of gross domestic product on public health. On the other hand it would cost the world $6bn to stop women dying during childbirth less than the amount spent in a day and a half on the military. Also sound economic investment could go a long way to bring success in countries across Asia pushing down the poverty levels. At the same time political priorities, if geared towards health-related MDGs will help save women from dying, reduce child mortality rate, combat HIV/Aids, promote gender equality and eradicate extreme poverty and hunger globally (Holmes 2008).
Another discipline of importance is sociology which has also played an effective role in promoting health. Sociology enables us to understand the structure and dynamics of society, it attempts to analyse the patterns of human behaviour and individual life changes. It also examines the different forms of social structures like groups, organisations, communities and social categories such as gender, age and race and various social institutions like kinship, political, economic or religious groups that affect human attitudes, actions, values and beliefs as well as opportunities (Thorogood 2004 cited in Macdonald and Bunton 2004).
The significance of this has highlighted an understanding into how health and illness affect our everyday life and has also criticised medicine as a tool to support capitalist development and exploitation (Navarro 1974; Doyal and Pennell 1979). According to Illich (1976), medical dominance has done a lot of harm than good for example the practice of biomedicine has created a lot of sicknesses as a result from the risk of surgery, anaesthesia, effects of drugs and immunisations. This has also open ways to examine and to improve ways of different factors of health issues that is beyond the field of medicine and which the medical world does not have an adept opinion, and sociology can offer an insight into how and why these progressions occur. These also include the family structure, housing problems and employment issues as well as policies and suggest ways to address them (McKeown 1979; Kennedy 1983; Townsend and Davidson 1982).
The adoption of health promotion strategies has come under scrutiny in a sense that not only does the approach of information-giving is enough to change a person but then the issue of empowerment model that is gaining greater control and making a free choice (Tones 1986 ). For example health promotion campaign in recent times has not been successful to address the issues relating to educational responses to HIV/AID. There has been various criticism in the approach with regards to norms and values that has been associated to targeted groups and more importantly the ideas and values that binds the campaign which were not expressed (Watney 1988a).The issue of impasse facing government-sponsored programmes between agencies have been emphasised, on one hand and need for appropriate information on a vital public health issue on the other as well as a political and social unwillingness to support the profile of sex (Wellings 1988; Watney 1988b). The reasons for this tension is perhaps the sensitivity of undertaking any public educational activities which addressed forms of sexual relationship that might misinterpreted and could damage the traditional family values (Jessopp and Thorogood 1990). This can be achieved by carefully adopting a skilful decision-making strategy of acknowledging the individual social and political views as well as the structure of the community and their pre-existing values and beliefs. This will influence the ways in which information is perceived and operated on, decision-making and choice (Thorogood 2004 cited in Macdonald and Bunton 2004).
Another area that has been criticised is the concept of evidence-base to inform health promotion policy and practice for achieving health outcomes (Bowen and Zwei 2005). Programmes designed to support evidence-base health promotion (EBHP) are being investigated and discussions are on-going to find out which mechanism could be most effective to support the evidence into policy practice and relevance of practice guidelines. Even though resources can be found in large organisations that are responsible for making sure the implementation of policy and supporting EBHP practices and decision making processes (Davies 2005; Speller et al. 2005), there are well documented barriers that include lack of aptness, lack of relevance of research, mutual mistrust and lack of personal contact between researchers, policy-makers and practitioners, poor quality research, political instability, resource limitations and lack of expert opinion to explain evidence. Though many organisations are making sure to develop strategies to alleviate these barriers, there is still limited published research discovering the experiences of practitioners in the interest of evidence-based resources to inform practices. But in seeking to improve the evidence-base for health promotion and public health a multi-dimensional approach is required (Nutbeam 1999; Tang et al. 2003).
This essay to a large extent has given an insight into understanding the concepts, principles and models of health as well as public health and health promotion as being applied in a national and global context. It has also highlighted in a broader perspective understanding as to the way in which psychology has contributed effectively in a more rigorous application of psychological theories within health promotion interventions and evaluation designs (schaalma et al. 1996). And more also as a discipline to a large extent the contribution made in economics to health Promotion in identifying which forms of health promotion are worthwhile and which is not and therefore provided a framework which enables identification of where the benefits of health promotion justify the cost and to what extent. Lastly understanding the relevance of sociology for health promotion which has helped to outline the broad basis of sociological methods, considering the contribution this method has made or might make and the criticism of health promotion, both in its methods and in its goals and objectives.
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