Health Promoting Settings

Milka Donchin MD, MPH

Braun School of Public Health & community Medicine Jerusalem

Main activities in Health Promotion

Settings

programs
training

The setting-based approach

A setting is a social system in which people live,

work, learn, love and play

Characterized by a particular organizational culture,

structure, functions, norms and values.

The setting-based approach

A setting is the context

within which and through which

health occur

The setting-based approach

A holistic and socio-ecological model of health
Focus on populations, policy and environments Protect human rights, equity and social justice

sustainability
Community participation

Enablement and empowerment Cooperation

The setting-based approach

Key elements: A healthy working and living environments Integrating health promotion into the daily activities of the setting Reaching out into the community

The setting-based approach

Underpinned by: Health for all Ottawa Charter Agenda 21

Sustainable Development

'development which meets the needs

of the present without compromising

the ability of future generations to

meet their own needs'

Principles for Sustainable Development in Israel (partly) Agenda 21 Integrated Resource Management Eco-Efficiency

Inter-generational and
Intra-generational Equity

Polluter Pays User Pays Sustainable Consumption

Environmental and
Social Justice

Accountability and
Transparency

Source: European Sustainable Development and Health Series:1

The first health promoting setting Healthy cities

A Healthy City
One in which residents, business, nongovernmental organizations and the municipal government work together to ensure a viable and livable city.

Healthy cities networks

Israel network of healthy cities

Established in 1990 with 4 cities

In 2012 50 cities & local authorities,

& 4 regional authorities

Covers >50% of the population in Israel

Israel Network of Healthy Cities

In operation since 1990
A member of the European Network of National Healthy Cities Networks , lead by WHO A unit of the Union of Local Authorities Institutions
School of Public Health, Jerusalem Israel cancer Association Nature protection society Community centers association 4 HMOs Beterm Enosh Milenium Association of cardiologists IMA

Members of the Network

Cities Local councils Regional councils Individuals Ministries
Health Education Environment Welfare Sports

Membership Criteria for cities

A formal decision of the city council to adopt HFA principles

Nominate a multi-sectoral steering committee

Nominate a city health coordinator A commitment to prepare a city health profile A commitment to prepare a strategic health development
plan based on the profile

A commitment to cooperate with the networks activities.

The Healthy City mode of action

Steering committee
City profile

Health promotion projects

Sustainable development projects

Strategic planning for health & sustainable development Action plans in city settings

City health profile

Identify needs of the population Determine inequalities in health Identify desires and aspiration of the citizens

City Health Profiles

All Healthy Cities are committed to preparing a City Health Profile as a basis for their strategic planning for Health for All and Sustainable Development

The profile includes:

data on the state of health of the population socio-economic and environmental determinants Identification of social and health inequalities Mapping of the services in the city and their usage

A toolkit for preparing city profile

Enable standardization A CITY PROFILE A basis for strategic planning for health and sustainable developments GUIDELINES Updated version 2010

Has operational
definitions Forms for extracting information A questionnaire

The profile a joint effort

Expert network team City coordinator & local team
collect data from national sources facilitators and consultants to the city coordinators and their teams Define determinants for inequalities and vulnerable groups

collect data from municipal sources

CBS

provide population random samples and weights for population estimates

Selected results

Selected characteristics
Z-N
Socio-economic cluster Median age % of families with 4+ children % entitled to matriculation certificate of 12th graders % elderly receiving supplement income 7 31 5.6 70.2

P-T
6 33 8.8 61.3

Ash
5 30 16.2 55.9

15.7

25.7

49.6

Participated in the surveys aged 22+

city

Z-N
489
77.9 2008

P-T
414
66.2 2007-8

Ash
539
86.2 2006-7

N
Response rate Year of conducting the survey

Selected characteristics of the population in geographical areas

P-T Ash

Social capital

Trust people

Mutual support

lifestyles
Z-N
Rate of smokers Rate of physically 3+/w 50+ women performed mammography
20.8

P-T
20.0

Ash
27.5

40.3

33.4

12.7

62.1

68.6

46.2

Women aged 50+ performed screening mammography (%)

Self assessment of health by areas in cities and age

Predictors of assessing health as good-very good in P-T - Logistic regression

OR C.I

P
<0.001

Age

22-44 45-64

5.3 0.6

1.8-16.2 0.3-1.4

65+

immigration Israeli born Immigrated before 1990 Immigrated 1990+ Employment Yes
8.4 3.8-18.8 5.2 1.8 1 2.3-11.8 0.8-4.2

<0.001

<0.001
1

No
Satisfaction from life
Yes no

0.002
3.6 1 1.6-8.0

Predictors of assessing health as good-very good in N-Z- Logistic regression

OR Age 22-44 45-64 65+ 11.9 3.1 1 1.1 2.5 1 1.0-1.3 1.0-6.2 3.4-41.1 1.3-7.5 C.I

P
<0.001

Education Employment
Yes no Satisfaction from life yes No

0.015 0.041

0.003
4.0 1 1.6-10.1

Environmental and social nuisances

N-Z P-T

conclusions
Variation in population composition exists within and between cities Inequalities between geographical areas in each city are determined by the population mix as well as by their physical and social environments Predictors of self assessment of health are not identical in different cities. A city health profile should be performed in each city as a basis for identifying and prioritizing needs and as a basis for evaluating the implementation of a health equity policy.

Strategic health development plan

Based on needs assessment

Integrates public desires and aspirations

Has a participatory planning process

Is integrated in the city action plans

Haifa

Haifa - a healthy city

Narrowing gaps, answer needs, improving quality of services
Reduce injuries

Work places

Community centers municipality

Schools & kindergartens

Improve the environment

Awareness Reduce smoking Physical activity

Deprived neighborhoods

Health services

Towards an active city

The Haifa forum for healthy & active living Steering committee Sharing knowledge and experience Mapping needs & assets Political commitment Participatory planning process

Determinants of physical activity

What works?
multi-component interventions that are adapted to the local context were found to be the most successful. Effective interventions invariably involved participants in the planning and implementation stages, such as involving the workers themselves in workplace interventions, and community leaders in community

and..

WHO, 2009

Evaluation framework

WHO global strategy on diet, physical activity and health: a framework to monitor and evaluate implementation, 2008

Health promoting hospitals - HPH

Health promoting hospitals

The health promoting hospitals (HPH) project and network facilitates change to promote total quality management of the hospital. It produces evidence to help hospitals achieve their health mission and to support cooperation and exchanges of experience between participating hospitals.

http://www.euro.who.int/healthpromohosp

objectives:
To change the culture of hospital care towards interdisciplinary working, transparent decisionmaking and with active involvement of patients and partners. To evaluate health promotion activities in the health care setting and build an evidence-base in this area. To incorporate standards and indicators for health promotion in existing quality management systems at hospital and at national levels.

hospitals - Health promoting hospital

promote human dignity, equity and solidarity, and professional ethics, acknowledging differences in the needs, values and cultures of different population groups; be oriented towards quality improvement, the well-being of patients, relatives and staff, protection of the environment and realization of the potential to become learning organizations;
The Vienna Recommendations, adopted at the 3rd Workshop of National/Regional Health Promoting Hospitals Network Coordinators, Vienna, 16 April 1997

Standards of a HPH
1. A hospital has a written policy for health promotion. This policy must be implemented as part of the overall organization quality system and is aiming to improve health outcomes. It is stated that the policy is aimed at patients, relatives and staff. 2. describes the organizations' obligation to ensure the assessment of the patients' needs for health promotion, disease prevention and rehabilitation.

3. the organization must provide the patient with information on significant factors concerning their disease or health condition and health promotion interventions should be established in all patients' pathways. 4. gives the management the responsibility to establish conditions for the development of the hospital as a healthy workplace. 5. deals with continuity and cooperation, demanding a planned approach to collaboration with other health service sectors and institutions.

Universities
Teaching health promotion in all schools of public health Health promotion university

J. Orme and M. Dooris, HEALTH EDUCATION RESEARCH, 2010, 25:437425

thanks