Health promotion is a process that aims at attaining the full mental, physical and well-being of people in society. It enables people to have total control of their health and as a result of this improved their life. Health promotion enables people to increase control over their own health. Currently, within health, there are six different health promotion models.
The medical approach focuses on activity that aims to reduce morbidity and premature mortality. This activity is targeted towards whole populations or high-risk groups. This kind of health promotion seeks to increase medical intervention which will prevent ill health and premature death. It seems to have three levels of intervention.
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Primary prevention – Prevention of the onset of disease through risk education e.g. immunisations, encouraging non-smoking.
Secondary prevention – Preventing the progress of disease e.g. screening.
Tertiary prevention – reducing further disability and suffering in those already ill; preventing recurrence of an illness e.g. rehabilitation, patient education.
The Behaviour change approach aims to encourage individuals to adopt healthy behaviours, which are the key to improved health. This approach is targeted towards individuals, although mass means of communication may be used to reach them. This can be seen on an individual, environmental and policy basis. These include changes in research showing the best ways to support people and make better health achievable wherever they are and whatever their individual circumstances.
The educational approach is to provide knowledge and information to develop the necessary skills so that people can make an informed choice about their health behaviour. The educational approach is distinguished from a behaviour approach in that it does not set out to persuade or motivate change in a particular direction. Education is intended to have the desired outcome.
The client-centred approach is not just about giving people whatever they want or providing information. It is about considering people's desires, values, family situation, social circumstances and lifestyle seeing the person as an individual and working towards developing solutions. Encouraging people to speak about what they find important, helping to develop a shared understanding of what matters to them. (Health Education England (2017)
The societal-change approach is a specialised health promotion that aims to improve social, economic and environmental living conditions. This approach aims to change society not individual behaviour, it is targeted towards groups and populations – for example, the smoking in public areas ban that was introduced in 2007. This now makes it illegal to smoke in all public enclosed areas and workplaces. (Health innovations (2019)
The shock tactics approach is a strategy that uses violent or extreme action or imagery to shock someone into doing something. For example, the TV advert featuring a tumour growing on a cigarette as it is smoked, which is designed to make the invisible damage caused by cigarettes visible. This is a careful balancing act, there is a need to grab attention then get the person to interact with the warning but not feel victimized. (BBC (2003)
Although health promotion aims to improve well-being there are also ethical issues to consider. It is not the place of health professionals to make value judgments on the way others choose to live.
Looking at the different models of health approaches there seems to be many similarities and differences. The similarities between the behaviour change and educational change are that they both rely on providing information to the patient either via leaflets/booklets / visual displays or one piece of advice. The educational approach has assumptions about the relationship between knowledge and behaviour, by increasing knowledge, there will be a change in attitudes, which may lead to change behaviour. The educational approach helps provide information to help clients to make informed choices about their health behaviour. The behaviour change approach relies on campaigns to persuade people to desist from smoking, adopt a healthy diet and taking regular exercise. Both these approaches have the same method of delivering the information, both require individuals to listen and learn. Patient education about a condition or medication may seek to ensure compliance which leads to having behavioural change. The educational approach is linked to the medical approach as without education people wouldn’t realise the importance of screening and immunizations for the medical approach to work. Some of the major differences that come between the medical approach and the behaviour approach are, the medical approach is regarded as high status because it uses scientific methods and is expertly led. Prevention and early detection of disease are much cheaper than treatment of people who have become ill, an example of this would be the MMR vaccine, which made Britain have a measle free status until recently. The principle of preventive services such as immunisation and screening is that they are targeted to groups at risk from a particular condition. Whilst immunisation requires a certain level of uptake for it to be effective, screening is offered to specific groups for example cervical screening is offered every 3 to 5 years in women aged 25 to 64. Having screening or immunization facilities available is only effective if people can be persuaded to have them. This is the link to the educational approach. While the behaviour changes approach views health as the property of individuals. People can then make improvements to their own health by choosing to change their lifestyles. Changes in behaviour may be a response to the conditions in which people live, the cause of these conditions e.g. unemployment and poverty are outside an individual’s control. (Health innovation network.
Issues relating to funding and lack of resources are major problems in health promotion. Staff shortages mean nurses will be dealing with health promotion on top of dealing with direct care of patients. Health promotion will cut down costs for the economy by tackling health problems such as obesity, cardiovascular disease and cancer. Health promotion is prevention, it is the practice of preventing disease and promoting good health within groups of people from small communities to entire countries. Instead of telling a person what they must do to improve their health, promotion is about finding out what the person would like to see improve, how they think it can be improved and how ready they are to make the change. This is explained in the cycle of change model – pre-contemplation (shock tactics) not thinking seriously about the change, contemplate (educational) beginning to think about our behaviour, prepare / determination (behaviour change) now ready to change, action (medical approach) – we now want to change, maintenance (person-centred approach) – which is the aim of the whole change model to get to a position where we can maintain and relapse recognising a step back to pre-contemplation. The idea of making every contact count is a very effective way of promoting good health and exploring this with the patient. The medical approach overall aim is to reduce morbidity and premature mortality by targeting risk groups or risk behaviours with medical intervention – the main example of an effective medical approach is the measles elimination, up until September 2019 the UK had a measles elimination status due to the uptake of the MMR vaccination. Proving that the medical approach is effective health promotion, however without the educational approach making people aware of the dangers etc of measles the medical approach wouldn’t have been as successful.
Take the flu vaccination this year record numbers of people in England will be offered a flu vaccine this winter. For the first time, all primary school children will be offered the nasal spray It will be available to over 25 million people and the aim is to urge those at risk of suffering from or spreading flu to ensure they get their free vaccination. As it is estimated that around 10000 deaths last year were attributed to influenza infections (Seqirus UK limited leaflet 2019) This is a medical approach initiative however it needs the backing of the educational approach to spread the word and educate people on why they need to be vaccinated. It is targeted at those who are at higher risk such as the over 65, pregnant women and anyone with an underlying health condition from the age of 6 months. From this year 2019, the nasal spray vaccine will also be offered to any child at primary school age. It is also targeted at specific areas such as residential care homes and from line NHS staff. The main purpose of the initiative is to reduce the number of deaths from flu and to raise awareness of the dangers of catching influenza and how its spread. You will hear and see many campaigns for the flu vaccination on your GP surgery, you may receive a letter or phone call from your GP directly, it is also advertised on TV and in supermarkets. With the use of social media, campaigns are now been brought online and will be circulated via Facebook/Twitter / Instagram etc. How effective the campaign is depends on many variants such as the vaccination that must be given at the start of the flu season which is generally September to November. This is a free vaccination if you hit the above criteria or you can pay privately at a pharmacy. (NHS (2019) Reported end of season flu vaccine effectiveness for 2018 to 2019 against all strains was:
44.3 % across all ages, 48.6% for 2 to 17-year olds attenuated influenza vaccine (nasal spray) 44.2% for 18 to 64-year olds (any vaccine) 49.9% for those aged 65 and over and 62% for those aged 65 and over (adjuvanted trivalent influenza vaccine only) (Public health England (2019) There are a few campaigns for the flu vaccination such as Stay well in winter, NHS111, FLU its too big to ignore.
According to Public health matters.gov.uk, the new enhanced vaccine has the potential to lead to 30000 fewer GP appointments, 2000 fewer people needing hospital care and 700 fewer deaths from flu in England. Influenza infection can result in mortality and morbidity, especially in frail older populations and in residential settings. The flu vaccination is a powerful mechanism for prevention.
Change for life is a government campaign that involves eating well, move more, live longer. Alcohol focuses the UK - This is a UK national charity that works towards reducing the harm caused by alcohol. Drink aware – This aims to promote responsible drinking and find NSF ways to challenge the national drinking culture to help reduce alcohol misuse and minimise alcohol-related harm.
The NHS contribute a huge amount towards public health by offering a free national health service, offering free vaccinations such as the MMR and flu prevention. According to ‘health.org.uk’, the quality of and access to health care is estimated to account for 10-20% of what contributes to people’s health. There have been many changes to public health in recent decades some of the achievements include – Increases in life expectancy since 1981 life expectancy if men in England has increased from 70.9 to 79.4 years and for women has increased from 76.9 to 83.3 years. Reduction in numbers of people smoking e.g. ban on smoking in public places is estimated to have saved the NHS over £380 million a year. Putting fluoride into drinking water has resulted in reduced tooth decay and tooth loss. Fewer infectious diseases e.g. typhoid and tuberculosis.
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