Health promotion

The ‘promotion of health’ has become everybody’s business: from the marketers of ‘healthy’ products and lifestyles, and gym memberships; government media campaigns to ‘Go for 2&5®’ (fruit and vegetables every day), special ‘extra’ benefits for joining a private health insurance fund and workplace ‘wellness’ programs that include yoga and pilates. For consumers, the list is endless. Health professionals need to understand the background to this growth in the promotion of ‘health’ and the place health promotion plays in public health. We begin this chapter with a discussion on health education, we then trace the evolution of health promotion from health education, the strategies and settings for health promotion, and conclude with challenges for health promotion. Case studies, activities and reflections on the material are presented to assist you.

Defining health and public health

- define health and public health - discuss how the concept of ‘health’ means different things to different individuals and be able to consider the range of factors that influence these definitions - identify and describe the principles of public health - recognise and describe how public health is defined and how each definition has shaped the development and implementation of public health approaches - describe the relationship between public health and other disciplines - discuss the nature and scope of public health - describe the varying roles of the public health workforce

History and development of public health

- briefly describe the importance of public health history to contemporary public health - briefly describe the ancient history of public health - outline the key periods and activities in the modern history of Western public health - describe and understand the important roles of political, social, environmental and economic factors as they impact on health - consider the major factors that have influenced an understanding of contemporary public health in the past 40 years.

Biological and environmental determinants

- describe the complex web of determinants as part of broad causal pathways that affect health - identify and discuss the range of physical, biological and environmental determinants that impact on health - suggest why it is important to the practice of public health that you understand how determinants contribute to health - understand the complexity of health and illness and the multifaceted role of health determinants - relate determinants of health to public health activity and realise the need for multisectoral action and multiple approaches when working to improve health

The future for public health

What is the future for public health in the twenty first century? Can we glean an idea about the future of public health from its past? As Winston Churchill once said ‘the further backward you look, the further forward you can see’. What then can we see in the history of public health that gives us an idea of where public health might be headed in the future? In the twentieth century there was substantial progress in public health in Australia. These improvements were brought about through a number of factors. In part, improvements were due to improved knowledge about the natural history of disease and its treatment. Added to this knowledge was a shifting focus from legislative measures to protect health, to the emergence of improved promotion and prevention strategies and a general improvement in social and economic conditions for people living in countries like Australia. The same could not, however, be said for poorer countries, many of whom have the most fundamental of sanitary and health protection issues still to deal with. For example, in sub-Saharan Africa and Russia, the decline in life expectancy may be an aberration or it may be related to a range of interconnected factors. In Russia, factors such as alcoholism, violence, suicide, accidents and cardiovascular disease could be contributing to the falling life expectancy (McMichael & Butler 2007). In sub-Saharan Africa, a range of issues such as HIV/AIDS, poverty, malaria, tuberculosis, undernutrition, totally inadequate infrastructure, gender inequality, conflict and violence, political taboos and a complete lack of political will, have all contributed to a dramatic drop in life expectancy (McMichael & Butler 2007).

Power relations and small and medium-sized enterprise strategies for capturing value in global production networks: visual effects (VFX) service firm in the Hollywood film industry

Power relations and small and medium-sized enterprise strategies for capturing value in global production networks: visual effects (VFX) service firms in the Hollywood film industry, Regional Studies. This paper provides insights into the way in which non-lead firms manoeuvre in global value chains in the pursuit of a larger share of revenue and how power relations affect these manoeuvres. It examines the nature of value capture and power relations in the global supply of visual effects (VFX) services and the range of strategies VFX firms adopt to capture higher value in the global value chain. The analysis is based on a total of thirty-six interviews with informants in the industry in Australia, the United Kingdom and Canada, and a database of VFX credits for 3323 visual products for 640 VFX firms.

Determinants of China’s regional innovation capacity

This paper investigates the determinants of China’s regional innovation capacity (RIC) and variations in these determinants between different types of regions. Based on the framework of national innovation capacity (NIC) and research on innovation system, this paper develops a framework of RIC in the Chinese context. Using panel data from 1991 to 2009, clustering analysis is first employed to classify regions according to their innovation development path. Panel data regressions with fixed effect model are conducted to explore the determinants of RIC and how these vary across the different regional clusters. We find that the 30 regions can be clustered into three groups, and there are considerable differences in the drivers of RIC between these different regional groups.

Comparing retail union strategy in a neoliberal context : the case of Australia and New Zealand

Retail employees are amongst the most vulnerable workers in the context of neoliberal market economies. In many countries, low paid retail employees comprise around 10 per cent of the workforce (ABS 2011). The retail labour market is typically highly feminised and youthful, with many employees in part time and various forms of precarious employment (Tailby & Pollert 2011). However, the industry and its trade unions have rarely been the focus of academic study (Tilly & Carré 2011). This paper thus aims to analyse and compare trade union strategies in the retail industry in Australia and New Zealand, by utilising findings from a larger comparative study. The respective unions studied are the Shop Distributive and Allied Workers Union (SDA) in Australia and the National Distribution Union (NDU) in New Zealand. Data from interviews with union officials at different levels and from different regional locations in Australia and NZ are analysed. Union policy documents are also utilised to support the empirical data. Key findings from the comparison of retail unions’ strategy in Australia and NZ include: 1) the importance of institutional factors and internal political differences in shaping and constraining union strategies; 2) different emphases on external relationships and variations in partnership approaches; 3) the need to recruit to ‘stand still’ by retail unions in both countries; and, 4) similarities and differences in the unions’ organising approaches. The paper concludes by examining the implications of these findings for retail unions’ strategic choices and their ability to deliver workplace justice for employees.

"Silly hours" : facilitating more effective part-time work arrangements through job design

Part-time employment presents a conundrum in that it facilitates work-life priorities, while also, compared to equivalent full-time roles, attracting penalties such as diminished career prospects and lower commensurate remuneration. Recently, some promising theoretical developments in the job/work design literature suggest that consideration of work design may redress some of the penalties associated with part-time work. Adopting the framework of the Elaborated Model of Work Design by Parker and colleagues (2001), we examined this possibility through interviews with part-time professional service employees and their supervisors. The findings revealed that in organizations characterised by cultural norms of extended working hours and a singular-focused commitment to work, part-time roles were often inadequately re-designed when adapted from full-time arrangements. The findings also demonstrated that certain work design characteristics (e.g. predictability of work-flow, interdependencies with co-workers) render some roles more suitable for part-time arrangements than others. The research provides insights into gaps between policy objectives and outcomes associated with part-time work, challenges assumptions about the limitations of part-time roles, and suggests re-design strategies for more effective part-time arrangements.

A fragment of the LG3 peptide of endorepellin is present in the urine of physically active mining workers : a potential marker of physical activity

Biomarker analysis has been implemented in sports research in an attempt to monitor the effects of exertion and fatigue in athletes. This study proposed that while such biomarkers may be useful for monitoring injury risk in workers, proteomic approaches might also be utilised to identify novel exertion or injury markers. We found that urinary urea and cortisol levels were significantly elevated in mining workers following a 12 hour overnight shift. These levels failed to return to baseline over 24h in the more active maintenance crew compared to truck drivers (operators) suggesting a lack of recovery between shifts. Use of a SELDI-TOF MS approach to detect novel exertion or injury markers revealed a spectral feature which was associated with workers in both work categories who were engaged in higher levels of physical activity. This feature was identified as the LG3 peptide, a C-terminal fragment of the anti-angiogenic / anti-tumourigenic protein endorepellin. This finding suggests that urinary LG3 peptide may be a biomarker of physical activity. It is also possible that the activity mediated release of LG3 / endorepellin into the circulation may represent a biological mechanism for the known inverse association between physical activity and cancer risk / survival.

Evolution of life drama program

Life Drama is a program of drama-based experiential learning activities involving groups of community leaders and members. The three-year project evolved from a theatre-in-education approach to an intercultural theatre approach incorporating Papua New Guinean performance traditions. It involved Australian, English and Papua New Guinean researchers at four key sites: Tari, Southern Highlands Province; Port Moresby, National Capital District; Madang, Madang Province; and Karkar Island, Madang Province. The project was innovative in a number of ways, including: a Participatory Action Research approach, involving community leaders at various levels as co-researchers; a participatory theatre approach as opposed to a performance approach; emphasis on sexual health promotion and HIV prevention through an experiential learning paradigm; addressing the norms and realities of the community rather than targeting only individual behaviour; an International Theatre Research Laboratory to explore the fusion of traditional cultural elements with contemporary health promotion aims; and an innovative method-assemblage approach to collecting and triangulating quantitative, qualitative, and performative data. The project attracted over $350,000 in funding and support from the Australian Research Council, National AIDS Secretariat in PNG, and private sector and non-government partners. Findings were presented at various conferences and symposia including the annual Medical Symposium in Wewak (2010), the triennial Research in Drama Education conference in Exeter (2011), and the International Research in Drama Education conference (Sydney 2009 and Limerick 2012). A number of peer-reviewed journal articles have been published. Elements of the program have been incorporated into the University of Goroka's compulsory HIV awareness program for undergraduate students. A national dissemination strategy for Life Drama in Papua New Guinea is now underway, with seed funding of AUD$74,000 from the National AIDS Council Secretariat, PNG.

Confirmatory factor analysis of the Behaviour of Young Novice Drivers Scale (BYNDS)

The greatly increased risk of being killed or injured in a car crash for the young novice driver has been recognised in the road safety and injury prevention literature for decades. Risky driving behaviour has consistently been found to contribute to traffic crashes. Researchers have devised a number of instruments to measure this risky driving behaviour. One tool developed specifically to measure the risky behaviour of young novice drivers is the Behaviour of Young Novice Drivers Scale (BYNDS) (Scott-Parker et al., 2010). The BYNDS consists of 44 items comprising five subscales for transient violations, fixed violations, misjudgement, risky driving exposure, and driving in response to their mood. The factor structure of the BYNDS has not been examined since its development in a matched sample of 476 novice drivers aged 17-25 years. Method: The current research attempted to refine the BYNDS and explore its relationship with the self-reported crash and offence involvement and driving intentions of 390 drivers aged 17-25 years (M = 18.23, SD = 1.58) in Queensland, Australia, during their first six months of independent driving with a Provisional (intermediate) driver’s licence. A confirmatory factor analysis was undertaken examining the fit of the originally proposed BYNDS measurement model. Results: The model was not a good fit to the data. A number of iterations removed items with low factor loadings, resulting in a 36-item revised BYNDS which was a good fit to the data. The revised BYNDS was highly internally consistent. Crashes were associated with fixed violations, risky driving exposure, and misjudgement; offences were moderately associated with risky driving exposure and transient violations; and road-rule compliance intentions were highly associated with transient violations. Conclusions: Applications of the BYNDS in other young novice driver populations will further explore the factor structure of both the original and revised BYNDS. The relationships between BYNDS subscales and self-reported risky behaviour and attitudes can also inform countermeasure development, such as targeting young novice driver non-compliance through enforcement and education initiatives.

Young, inexperienced and on the road : do novice drivers comply with road rules?

The graduated driver licensing (GDL) program in Queensland, Australia, was considerably enhanced in July 2007. This paper explores the compliance of young Learner and Provisional (intermediate) drivers with current GDL requirements and general road rules. Unsupervised driving, Learner logbook accuracy, and experiences of punishment avoidance were explored, along with speeding as a Provisional driver. Participants (609 females; M = 17.43 years) self-reported sociodemographic characteristics, driving behaviours and licensing experiences as Learners. A subset of participants (238 females, 105 males) completed another survey six months later exploring their Provisional behaviours and experiences. While the majority of the participants reported compliance with both the GDL requirements and general road rules such as stopping at red lights on their Learner licence; a considerable proportion reported speeding. Furthermore, they reported becoming less compliant during the Provisional phase, particularly with speed limits. Self-reported speeding was predicted by younger age at licensure, being in a relationship, driving unsupervised, submitting inaccurate Learner logbooks, and speeding as a Learner. Enforcement and education countermeasures should focus upon curtailing noncompliance, targeting speeding in particular. Novice drivers should be encouraged to comply with all road rules, including speed limits, and safe driving behaviours should be developed and reinforced during the Learner and early Provisional periods. Novice drivers have been found to model their parents’ driving, and parents are pivotal in regulating novice driving. It is vital young novice drivers and parents alike are encouraged to comply with all road rules, including GDL requirements.

Sustaining a healthy workforce

The changing demographics of the mining workforce and the increasing demand for skilled workers increases the importance of sustaining a healthy workforce now and for the future. Although health is strongly related to safety, the two areas are not well integrated and the relationship is poorly understood. As such there is an important need to raise the profile of health within the Occupational Health and Safety (OH&S) domain. The mining industry carries health and safety risks, often greater than other occupations. Whilst the mining industry is regulated by stringent OH&S controls, the very nature of the work and environmental influences expose employees to a greater number of injury risk factors than many other industries. In contrast to its excellent safety record, compared to most other industries, the mining workforce has a high proportion of chronic health problems. These problems can be exacerbated by the ageing of the workforce, regional location of sites and organisational issues influencing work demands. A major focus has been on the treatment of these conditions with relatively limited attention to prevention strategies. An important prevention strategy is the raising of awareness among the workforce of health issues and the significant increase in the volume of health related information has provided an excellent opportunity to access relevant information. Unfortunately, this information is of varying quality, may not be evidence based, and may provide the wrong guidance to the development of interventions designed to improve health. Limited time of most employees and potential lack of knowledge of ability to differentiate quality information presents additional problems or barriers to increasing awareness of health issues...