WEEK ONE INTRODUCTION

8 priority areas of hprm y heart disease y y y y y y y cancer arthritis mental health type 2 diabetes asthma / pulmonary disorders injuries and falls prevention obesity

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Health promotion definition y A combination of educational and environmental supports for actions and conditions of living conducive to health Levels of prevention y Primary action before risk factors emerge y y Secondary early stage action disease risk factors Tertiary action to prevent reoccurrence rehabilitation

Approaches to prevention y Individual community population

Individual approaches Advantages: y y Intervention appropriate Interactive

y Reactive Disadvantages y y Limited impact on incidence Cost effectiveness and time

Community / population approaches Disadvantages y Insensitive to specific needs Advantages y Large potential to impact incidence y Time and cost effectiveness

Targets the environment and sustained impact

** combined individual and population approach is preferred option 21st century y y y y hprm challenges based on chronic disease involves education and environmental approaches focus will be on primary and secondary prevention individual strategies are important but need to focus on population

Week two evolution of health promotion9/1/2010 3:06:00 AM

Foundations Ancient Greece y Hippocrates and Hippocratic corpus ( body of work devised by y y y y y scholars) Physiocratic school of thought Natural theory of disease aetiology Viewed health as a dynamic equilibrium between man and his environment Greek society placed an emphasis on lifestyle behaviours which maintained this equilibrium More than just medical approach set standard for how we approach disesae Modern beginnings y Industrial revolution y y y y Movement from manual to machine based manufacture Massive concentrations of people in cities Cramped living conditions encouraged infectious epidemics In response to industrial revolution public health came to deal with infectious idseases The landscape of public health modern era y Communicable disease y y y y y y y Small pox vaccination 1796 edward jenner Pasteurization (1862 louis Pasteur and claude Bernard) Antiseptic (1867: joseph lister) John snows influence 1854 cholera epidemic Developed important epidemiological processes Encouraged the use of evidence to support practice and policy Provides an example of challenges that face health promoters in the real world

Changing nature of disease y From communicable or infectious (cholera, malaria, hiv, tb) to non communicable (diabetes, cvd, cancers, asthma)

Look closely at the WHO charters and how they shape contemporary approaches

WHO y y y Organization for effective health change Established 7th April 1948 in Geneva 193 member states, 6 regional areas

y responsible for providing leadership on global health matters initial milestones y y y y WHO 30th assembly 1977 resolved: attainment of all citizens of the world of a level of health that will permit a socially and economically productive life Declaration of alma ata 1978 134 nations. Emphasis on health education and primary prevention Ottawa charter 1986 first international conference on health promotion. A response to growing expectations for new public health movement Ottawa Five key action areas: y Health public policy y y y y Supportive environments Community action Development of personal skills Reorientations of health services

Onwards from Ottawa y Jakarta declaration on leading heath promotion into the 21st century reiterated Ottawa, emphasized infra strucure, investment and empowerment Bangkok charter for hprm political action, broad participation and sustained advocacy Nairobi charter 2009 y Implications for hprm y y y Transitional gap between research and practice Health gab between countries Health gap within Australia

y y y y y

Strengthen leadership and workforces Mainstream health promotion Empower communities and indiviuals Enhance participatory processes Build and apply knowledge alma atta Ottawa and 5 key areas Bangkok nairobi

30th assembly Trends globally y y y y y y y

20% of deaths are under 5 years old 1/3 of all deaths attributable to communicable, maternal and nutritional deficiencies developing countries have highest rate of communicable and chronic disease SES importance Substantial differences in health relative to SES in Australian population Those with highest ses have most resources etc Lower ses groups are more likely to: smoke, inactive, obese, eat less fruit, have diabetes, cvd, arthritis, mental health, problems, visit doctors and emergency services

Importance of health milestones y Drive national public health policy which determines individual environmental and sociocultural action

Week three health promotion perspective on practice 9/1/2010 3:06:00 AM

ROSE y y y y y y Professor of epidemiology Transformed approaches to health intervention and prevention strategies Large number of people at a small risk may Ive rise to more cases than small number at high risk Individual approach is strongly intervention appropriate Population approach is essential in tackling disease incidence DEAL WITH LARGER AMOUNT OF PEOPLE WHO ARE AT LOWER RISK TO EFFECTIVELY DEAL WITH INCIDENCE

Two key aetiology questions y y Why do some individuals have .. Why do some populations have a lot of whilst in others it is rare High risk / individual strategy y Why do some individuals have..? y y The deviant minority with the high risk status Is the traditional approach to medical prevention can base it on the individual want to stop being sick personally want to be successful in their job

Advantages y Intervention appropriate y y y y

High participant motivation High researcher motivation

Cost effective uses of resources big results for resources Benefit to risk ratio favorable push benefits while managing

risks disadvantages y y y y y screening ignores borderline people impact is palliate and temp take away support and people may return time and resource intensive behaviorally inappropriate goes against social norms does not deal with disease incidence

low risk / population strategy y why do some populations have a lot of .. while in others it is rare

public health orientated approach to preventative medicine

y shift population distribution of disease advantages y y y radical removes underlying causes of disease has large potential for change if distribution lowered by small amount = huge change in mortality behaviorally appropriate targets socio cultural norms and

environments disadvantages y big benefits to population but small to most individual

Notes from reading: ROSE SICK INDIVIDUALS AND SICK POPULATIONS y y y Central ethos of medicine: acceptance of responsibility for sick individuals Why did this patient get this disease at this time? To determine cause of disease depends on population and norms if everyone smoked 20 cigarettes a day then clinical case control studies would show that lung cancer was genetic this is true as everyone is exposed to the agent but cases are based on y susceptible Places where everyone is exposed case control is futile as everyone is exposed and other factors operate to determine the varying risk y y y More widespread a cause the less it explains the distribution Two determinants of incidence: first seeks causes of cases and second seeks cause of incidence What distinguishes two groups isnt about the individuals but about the whole distribution need to study characteristics of populations not of individuals y y Migrants acquire disease rates of country of adoption not on individual merits Two methods: differences between populations and differences in populations

High-risk strategy

Traditional approach, screening used. Detect and treat symptomless diseases. Patient goes from being well to being susceptible and having to do something about it

Advantages: y Intervention is appropriate to individuals y y y Subject motivation they are special and hence more motivated Physician motivated can make a difference and feel they are justified by tests etc done Cost effective use of resources once off advice is pointless, this method allows for counseling time and follow up more effective to concentrate limited services and time where there is need y Favorable benefit: risk ratio if intervention has some adverse costs and if the risk and cost are the same for everyone then the

ratio is favorable Disadvantages y Difficulties and costs of screening high cost to screen everyone, those who get screened are often least at risk of the diseases, screening finds people who receive advice but also finds a large number of borderlines for whom there is no treatment y y y Palliative and temporary effects doesnt get to root of disease but protects the vulnerable to it Potential is limited power to predict future is weak, most with risk factors will be well for an amount of time Behavioral ineffective if social norms are there, trends will not change as people will stick to norms

Population strategy y Attempts to control determinants of incidence, lower mean level of risk factors to shift whole distribution of exposure in a

favorable direction Advantages y y y Radical remove underlying causes that make disease common Large potential for population - affects whole population Behaviorally appropriate if non smoking becomes normal then people will not smoke social norms

Disadvantages y Small benefit to individual most of the people were going to be ok anyway little benefits to each participating individual

y y y

Poor motivation of subject

people act on immediate rewards

Poor motivation of physician practitioners disheartened at small results in prevention there is little expectation of benefit Benefit risk ratio is worrisome

Week 5 health promotion approaches, the individual approach

Ecological model: y Combination of individuals, society and culture, policy and environment What are individual approaches y Focusing on one person in group or multiple individual contacts y y y y y Can include facilitating others t provide individualized attention Assisting people to develop the knowledge, attitudes and skills they need to optimize health Vs working with environment, communities, organizations, settings, policies, regulations, systems, service delivery Assisting people to develop knowledge, attitudes and skills needed to optimize health Reflected in Ottawa and Nairobi charter

Why individual approaches y y y y y y y Clinical basis, secondary or tertiary management Educational basis Knowledge as a determinant Builds on relationship personal contact and influence Relevant to those involved reaches those most likely to benefit, cost effective use of resources Allows for personalization and individual tailoring meets individuals needs, allows for individual translations Can result in large amount of change for client but not for population

Examples of individual level hprm 5 TO REMEMBER ** y y y y y Patient education Self management Primary health care Risk factor assessments Education materials

Patient education y You are the leader

y y y y y y y y y

Helping individuals better informed about conditions, procedures choices Enables better self care and informed decisions Knowledge based Secondary or tertiary management Integrated into patient care Developed in conjunction with patients Interdisciplinary Measurable goals Combination of who delivers, setting, method of info transfer, topic, audience

examples y understanding surgical procedures y y y y y prescribing exercise regines based on fitness tests demonstrating use of an inhaler sex ed dealing with metnal health implications of bullying sun safety instructions

Self management y Individual involved in and responsible for aspects of treatments y y y Getting people to deal with issues and solve them via motivational processes Facilitate this as the HP professional Facilitating and letting patients take control

Main skills y Problem solving y y y y y y Decision making Resource utilization Formation of patient provider partnership Action planning Self tailoring Often involves acting as a counselor systematic guidance and

problem solving using your expertise and experience Motivational interviewing process of questioning to resolve ambivalence and increase motivation examples y pan management for arthritis

y y y y

carioca rehab diabetes caring for dementia stress management

Primary health care y Still dominant individual approach y y y y y y y y y y Continuity of care coordinate primary secondary tertiary Toward q2 highlights Universally accessible based on ideal of equitable distribution Resources for intermediate and long term needs Focus on first point of contact for health related issues General medical practice Common first contact Credibility Time constraints How affective are gps as hprm?

Alternative primary health care settings Pharmacies y Home health care providers y y information advice

venue for activities y government y y private telecommunications

risk factor assessments y y y blood screening lab, home and community testing lifestyle behaviours like diet and physical activity health risk appraisals, questionnaires, computer services

educational materials y informational brochures, information sheets, posters y y y prescriptional medication regime contractual gym, therapy evaluational diaries, log sheets

y y y y y

culturally specific accurate appealing easily comprehended pertinent to the desired objective

TOWARD Q2 NOTES federal and state priorities will be tested on health section of toward q2 key messages, what its asking us as citizens and experts to engage with * = key reading we need to read Q2 challenges highlighted y y y y y y y goals: y y y y y climate change unhealthy lifestyles preventable diseases growing population ageing state global competition entrenched disadvantaged

strong create diverse economy powered by bright ideas green protect lifestyle and environment smart deliver world class education nadn training healthy fair support safe an caring community

health goals y y y cut by 1/3 obesity, smoking, heavy drinking and unsafe sun exposure have shortest public hospital waiting times in Australia

Week 6 environmental approaches

environment includes y social physical

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how people interact together in different

contexts, within schools, within workplaces: social feelings and connections which are very important y perceived actual need to talk to people to see how they perceive the environment. People may perceive diet as healthy but may not be so built natural how cities are designed, how they link into parks etc macro micro key one on one environments

y y

Policy and the environment y y y y y y y Laws and legislation laws are adopted to guide individual and collective behaviour change legislation makes the healthy choice the only legal choice informal rules and regulations families healthy eating family rule: sit around the dinner table for a meal workplaces schools

Technology and environment y way we use technology to benefit and negatively impact our live benefits: y technology can impact the environment at a massive population y y costs y y energy balance many children sitting in front of tvs and games graph: even though we have increased energy expenditure with wii it will only contribute small difference to amount they need in a day not contributing that greatly to getting kids particularly active level internet connectivity: websites linking information to the population use Nintendo wii to increase energy expenditure

benefits y y costs y y sedentary nature of modern day living energy balance in and out medical breakthroughs vaccines internet connectivity links to community environments

advantages of environmental approaches y able to influence entire population y y y y y y acknowledge context cost effective can reach hard to reach who must respond if environment is changing radical lasting effect on behaviour useful in complex behaviours

Gilson experiment y did a pre intervention environmental audit y y y y y y looked at campus characteristics size etc then used audit to determine walk ability large differences in campus size, staff, length and route numbers sites 8 9 10 were very poor need to change this before started intervention these campus scored very low many campuses had poor traffic controls and poor cover on routes important in terms of sustainability due to weather changes

pop quiz y y y y most recently added aus gov health policy obesity how much did maccas pay the heart foundation for tick of approval 320 thousand Hippocrates and Hippocratic corpus developed the physiocratic school of thought director general of WHO Margret chow

y y y

when did Geoffrey rose publish his paper on individuals and populations 1985 who wrote the forward in the toward q2 document Anna bligh

according to q2 how many qlders are living with long term chronic condition 70%?

SOCIAL MARKETING AND POP RESEARCH9/1/2010 3:06:00 AM

What is marketing? y Process responsible for identifying, anticipating and satisfying customer requirements o Commercial marketing = financial gain y y o Social marketing benefits to people Trying to highlight benefits to people Commercial and social marketing beginning to blur as joint ventures with big corporations

Why do social marketing? y y y y y Rise in mass media, technology Focus on prevention and lifestyle conditions Individualism and free choice movement Need for persuasive communication and behaviour change Encouraging and advocating change

Methods of social marketing y Limited reach o Pamphlets o Info sheets o Newsletters o Posters o Tshirts o Videos, dvds y Mass reach o Television o Radio o Newspapers o Magazines o Internet y We are bombarded with images shock value may be effective

Mass media y Tool of social marketing used to educate, motivate and advocate at population level Social marketing: 6 principles

1. Consumer orientation o What are the audiences wants, needs and motivations o Eg why would people want good food: healthy family, but also want to save money- need

2. Concept of exchange o between supplier and consumer o acknowledges cost of product eg time money etc o what is got and what is given up? o Barriers and facilitators like time money and effort o What if spending the time etc gives little results?

3. Customer value: marketing mix o product, actual product, core product and augmented product o product: eg chicken free range o core product: healthier o augmented product: tshirts, stickers etc o price - consumers perspective better cheaper isn necessarily

o promotion how to involve people o place supermarkets, schools o people y ripple effect- info is passed on

4. Market segmentation o heterogeneous groups o divide market into segments and develop profile of each segment o develop marketing mix for each group o eg o demographic segmentation o risk factor segmentation identifying people most in need and attacking this group o stage segmentation divide by if they are ready to, thinking about or against change etc

5. Competition and differential advantage

o what advantages does the product have over competition? o Who else is offering similar products? o Who is offering what how do we deal with competition y 6. Market research o identifies consumer priorities and values o establishes how best to promote the heath issues o focus group and surveys may be used people involved in decisions o beginning middle and end of campaign o establish how best to promote health issue successful media campaigns y y y y y y y y review y y y y y social marketing is process through which we aim to facilitate social change for health 6 principles of it marketing mix is important concept different types of mass media approaches social marketing through mass media is effective for population change based on formative research fully understand the topic skilled creative personnel target the message credible source of spokesperson realistic goals and timeframes provide environmental supports for change scientific input

9/1/2010 3:06:00 AM EXAM REVIEW what health promotion is how its defined levels of health promotion primary secondary tertiary aware of individuals and populations be aware of key figures who contributed to hprm evolution john snow, Hippocrates, industrial revolution, how hprm grew out of these key developments policy issues WHO how developments in our area ran through Ottawa into alma atta into Bangkok to Nairobi levels of prevention and their importance primary, secondary, tertiary 20th century getting to large groups of people aware of government health priorities and their importance aware of recent findings in data around Australias health 2010 key issues we are dealing with? federal and state priorities will be tested on health section of toward q2 key messages, what its asking us as citizens and experts to engage with * = key reading we need to read Q2 aware of how things have progressed on from Ottawa not to be tested on Ottawa document itself will be tested on Nairobi its key commitments and its ethos readings that we have been highlighted as important for learning issues around individuals vs populations roses arguments MUST READ THIS PAPER have to be very aware of advantages and disadvantages of both approaches population section will take into account things weve talked about in regard to environment this week and social and cultural health promotion issues that we deal with next week aware of individual processes talked about 5 key processes patient education, self management etc

some questions will be factual, some around key figures and some around concepts