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Human health, public health and health’s promotion. Considerations. Human health Health promotion Public health Marcio Ulises Estrada Paneque. MD. Ph. D.
Human health. • WHO 2001: … complete physical, mental and social well-being state and not only absence of disease or ailment. • This medullary ideas conform the totality in health, although there are differences between ages, countries, cultures, classes and sorts that prevent a homogenous consensus on this definition. • Physical and mental health, and wellbeing/social health, cannot exist independent. • It belongs to interdependent dimensions.
Human health. • Health is the base for well-being and the effective life of an individual or a community. • Health and disease can exist simultaneously and are mutually exclusive only if the health is defined restrictively. • When recognizing health like a state of balance of the own, the other and the enviroment, the result is that individual and community look for to improve it.
Human health. • Health and disease are determined by many factors that interact in social, psychological and biological form, those that world-wide are associate with indicators of poverty and low levels of education. • Association of poverty and bad health happens in all societies, independent of its levels of development. • Factors like the insecurity, violence and changes of articles of incorporation and styles of risk life, increase the vulnerability and condition the propensity to the development of diseases.
Public health. • Public health is science and art to promote health, to prevent diseases and to prolong the life through organized efforts of the society. • The gains in health have been obtained as a result of improvements in the economic income, education, water provision, nutrition, hygiene, house, and health services. • It are also result of new knowledge on the causes, prevention and treatment of the diseases.
Public health challenges. • Demographic and epidemiologic changes, environment deterioration, modern life conditions in the great cities, accidents and chronic diseases constitute sanitary challenges in this century. • This scene requires to implement strategies of public health that prevent the diseases appearance and promote the total development of the health. • These challenges exist due to the priority of diseases treatment services by on promotion programs and primary prevention of diseases.
Advances in the Public Health • Implementation of policies that make possible more accessible intervention programs. • Individual combination of structural changes and actions. • 21 st century: What causes that the people are healthful? • Health genesis versus pathogenesis.
Stigmata for the global public health. • Every six seconds, a boy dies of hunger and is 1000 million hungry people in the planet. • Inequalities and lack of cover in the health. • Increasing prices and the climatic change events exacerbate this situation. • Causes: marginalization, poverty, lack of earth and employment and unjust international economic order.
Prevention of diseases and health promotion (HP). • Prevention of diseases and health promotion are different to each other, but their objectives are superposed. • Both interventions are complemented, although but promotion and reach the public to whom it goes directed are much more ample
Prevention of diseases. • Concept of prevention in health derives from the classic paradigm of public health that distinguishes three levels of prevention: ü Primary: Oriented to prevent diseases appearance in susceptible populations. It uses as much interventions of health promotion like specific protection. ü Secondary: Its objective is to shorten the disease duration once it has appeared, to reduce the contagion probability, and to limit sequels, through early diagnosis and opportune treatment.
Prevention of diseases. • Tertiary: Directed to people with irreversible diseases to which it is not had effective treatments. • It tries to preserve the functions, to diminish incapacity, to diminish underlying disease complications and to harness rehabilitation.
Preventive interventions. • Preventive interventions must take into account the diverse diseases causal factors, considering its biological, psychological and sociocultural components. • Actions must focus, with preference, at the level of public health instead of the individual level. • If is difference in the disease incidence or prevalence in comparable population groups, exists the possibility of realizing primary prevention.
Preventive interventions. • Preventive actions have inevitable repercussions in numerous health problems, besides specific condition to which they are directed. • Design of preventive interventions must be based on an ample conceptual model with impacts in diverse problems. • It must consider human conduct like a crucial factor. So that the prevention will be effective, it requires of individuals changes in attitudes and conducts at the same time as changes in the systems.
Health and disease. • Individual health is affected by individual factors, social interaction, cultural structures and values society resources • Economic levels have implications in the familiar health and mental health, social and conduct interact problems and intensify those implications. Substances abuse, mistreat and violence are consequences and factors that deepen those problems. • Health and disease has multi-factor origin and can exist of sequential and continuous form.
Differences in health concepts. • Nonprofessional people consider to be healthful when they do not have disease or they compare health with vitality and autonomy. • Majors adults define as an inner force and the capacity to confront life’s challenges. • Young people think about health like good physical training conditions, energy and strength. • Those that lives in prosperity think health about the context to enjoy the life and those of less resources think it like having the basic needs to live.
Health promotion (HP). • Health promotion, a still emergent field of action, frequently is defined of indirect form, examining primarily the health idea, when that term is vague in itself, because it can talk about as much to presentsstates show like disease or incapacity absentees. • Health can talk about a sufficiency state and aptitude, or usable individual resources when it are needed. • Different conceptions exist on health and its promotion, according to the diverse cultures and experiences.
Textual definitions on PH. • “Process that confer to the population means to assure a greater control on its own health and get it better“ (Ottawa Letter 1986); PAHO/OMS, 1996). • Strategy directed to the profit of an integral advance in life quality, every time in greater degree, like the sum of population actions, health services, sanitary authorities and other social and productive sectors, directed to the development of better conditions of individual and collective health ". (PAHO/WHO, 1996).
Influential factors in HP By his repercussion in theoretical and pragmatic aspects of the HP, this emphasize the following: ü Little precision in the concept of health and the responsibility that it infers. ü Multicausalty of health and disease. ü Little clarity in people in charge to develop it (sectors, communities, family and individual). ü Insufficient evidence on its effectiveness.
Promotion and health theories. • Unified theories of health, like the WHO one, include individual and environmental factors. • It implies that health promotion must focus so much to the individual as to environment, and surpass the medicine classic model centered in doctor and patient, or the supplier and the user.
Promotion and health prevention. • Promotion of health is action and law to approach, to modify the health determinants that are modifiable. • Promotion and prevention are activities that are related and superposed. • First one takes care of determinants and the second is concentrated in the diseases causes.
Promotion and health determinants. • Determinants are factors that improve or threaten the individual or community health state • It can be: ü of individual option (styles and habits), ü related to social, economic or environmental characteristics outside the individual control (class, sort, education and house) ü at communitarian level (social participation, demand and/or labor availability and quality of air and water)
Interventions in health promotion • Interventions of any level (local/national), can improve health. • Intervention strategies were defined in Ottawa letter (WHO 1986) with five strategies of action: ü To conform healthful public policies ü To fortify communitarian action ü To develop personal abilities ü Creation and protection of healthful atmosphere ü To reorient health services
Practice of health promotion. • Diverse surroundings of health promotion have common characteristics, based on the collaboration - action and social participation, and the functions of planning, implementation and evaluation of the programs. • All promotion models agree in which people potential is due to develop, to control and to protect its own health and to collaborate with others one
Health promotion models. • These models include: • Study of needs, resources, priorities, communitarian structure and participation “To make altogether instead of do for…” • Plan of action in consensus, management of resources, monitoring of action and changes • Emphasis in the evaluation and dissemination of best practices to improve the quality.
Evidence on health promotion. • From 1998, WHO promoted use approaches based on the evidence in the promotion actions. • Generation of evidences on effectiveness in health promotion is a challenge, since it is a social action and it is difficult to control it. • In order to measure its effectiveness, the consensus is based on the methodological triangulation, that allows to interpret evidences convergence of different classes, in different places and generated by different investigators.
Principle of prudence. • It recognizes that all evidence can have deficiencies, that never is possible to arrive to say as much as to act with absolute certainty, but that sufficient certainty on quality evidences allows to make recommendations for the action. • Evidence on effectiveness of health promotion derives from the investigation based on the community. • It’s not possible to be trusted the quantitative traditional measures totally. When including qualitative methods, will exist a better understanding of what it works and what no.
Force of the evidence in HP. • In health promotion two medullary questions with respect to the evidence exist: ü - The force that has and its implications for the investigation, the practice ü - The design of policies. • Evidence force is determined by the design of interventions and methodological aspects like validity and control of slants (falsificationprediction and repeatability). Evidence can be of four types.
Types of evidence and HP. • A: We knows what works, how it works and its repetition is universal. • B: We knows that it works, how it works and its repetition is limited. • C: Is known that it works, the repetition is universal, but is not known how it works. • D: Is known that it works, is not known how and repetition is limited.
Investigation in health promotion. • It works in an atmosphere where numerous factors interact: economic, social, cultural and political. • This complexity very often not allows to obtain the sufficient results to obtain evidences of type A. HP strives in obtaining evidences of the B type, which has implications for the practice. • Effectiveness of an intervention for HP, not always is guaranteed beforehand. Therefore evaluation investigation must be combined with the practice of HP.
Social capital and HP. • Concept of “social capital” has been assumed to reconstruct individual action in the investigation on SHD means, it is more than qualification to improve the individual productivity (capital human) and then it projects itself to social organization (networks and norms) that facilitates coordination and cooperation for mutual benefit. • Social capital is not a perception or individual resource, is for collective action and promotes growth, social and economic development. Relation between social capital, health and health promotion, is actually subjects of investigation and debates.
Social capital, risk and HP. • Population health measures and risk factors are considered like a sum of individual characteristics in a population. Environmental association of one or more factors and individual health. • Social capital approach them like interaction between environmental and social factors, and tie groups of individuals (perspective of networks), it explains the collective results variety, beyond the explained thing by the individual results of health. The social networks promote social cohesion, informal attention, protection in crisis and better education for health
Conceptual frame in HP action. It must be concentrated in: • Social and economic determinants of health (social inclusion, absence of inequities & discrimination and economic participation). • To include all different methodologies from HP that work concerning population. • To involve to all and different sectors becoming made responsible with HP.
Conceptual frame in HP action. Health promotion practice must: • Focus in the promotion of well-being instead of the disease. • To consider the population like a whole, including those that present risk conditions. • To orient itself towards action on health determinants such as income and house, rather on risk conditions and factors,
Conceptual frame in HP action. • To include an ample rank of strategies, such as communication, education, organizational change, communitarian development and local activities. • To recognize and reinforce population competitions. • To include sanitary and social aspects at the same time as medical services.
Health promotion components. • • • Social communication. Social learning. Intersectoral coordination. Social participation. Healthful surroundings. • Promotion of effective health, produces changes in health determinants.
Social communication and HP. • Mass media are a vehicle to canalize educative information, motivation and contents. In health promotion and prevention it serve to harness individual and collective conducts. • Programs arise from determined population evaluation of needs, susceptible to be boarded by means of these strategies. • It requires of problem knowledge and scientific evidence on the promotional or preventive interventions of greater effectiveness.
Social learning and HP. • Is a interactive, reflective and critical process in which participant people develop values, knowledge and abilities, through its active and experiential participation, to reinforce protective factors (promotion) and to modify risk factors (prevention). • Results are obtained favoring expression of creative capacity for construction of a collective knowledge, where contribution and experience of each participant contribute to the group learning.
Intersectoral coordination and HP. • Intersectoriality is the agreement of political and technical wills of diverse social sectors to implement integral proposals destined to improve the population health situation. • It complements approaches of different scopes, mobilizes resources and takes part jointly or coordinated around health. Thus it is avoided to duplicate to efforts and resources. • Intersectoriality occurs in all society organizational scopes, as much at national level as regional and local, considering public and private institutions.
Social participation and HP. • It is a real and effective capacity of people, families or groups to indirectly influence or make decisions on the health subjects that affects them directly. • It is a social process where all the actors identify needs or health problems and are united in an alliance to design and to put in practice solutions. • Social participation in health acts of shared in common form, evaluates and exerts a social control on health system.
Healthful surroundings. • People and communities environments formed not only by a physical dimension, but talk about social, economic, cultural and political aspects. • It constitute communities life conditions and are a great extent determining of people health. • Labor districts, communities, towns, schools and other centers are influential surroundings to become healthful.
Interventions in HP. • Directed to: ü General population. ü Vulnerable pre-school and babies. ü Schools children. ü Adults and majors adults in risk. ü Individuals and groups with previous health problems. ü Special groups.
Challenges in HP. • Health promotion is reduced and is confused with the health education • Family doctor roll in a the new vision of HP. • Improvement of formation and major stimulation by health promotion activities. • Major participation of directive, managers of all health centers and institutions. • Improve infrastructure for health promotion development in familiar medicine.
Conclusions. • Medicine and public health advance together with its styles of action. • Satisfaction, well-being and quality of life improvement of a person (ill, in risk or apparently healthful) and their surroundings are fruit of a joint work of health professionals and society. • If yesterday we dedicated ourselves to patient and risk, today is necessary to see people in his integrity, with a human and holistic base, harnessing his capacities, so that it can face the challenges of environment.
Conclusions. . . • If we yesterday saw the person in a clinical frame today we must see it beyond its surroundings: in the scope that lives, studies or work, with a holistic and integrating approach. • Enable and to do participates person, the community as far as health selfmanagement (Health promotion): this it is defied that public health professionals should face.