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.

Community-based asylum seekers’ use of primary health care services in Melbourne

Objective: To investigate primary health care service utilisation and health presentations among asylum seekers living in Melbourne. Design and setting: Retrospective audit of files of people who attended three Melbourne asylum-seeker health clinics between 1 July 2005 and 30 June 2006. Main outcome measures: Rates of reasons for the encounter, diagnostic tests or investigations required, treatments prescribed and referrals. Results: Data were collected from 998 consultations corresponding to 341 people. Eighty-eight per cent of visits involved people with no Medicare access, owing to their visa status. The most common reasons for the encounter were general and unspecified symptoms or problems (rate, 59.9 per 100 encounters; 95% CI, 55–65), followed by musculoskeletal conditions (27.1; 95% CI, 24–30), and psychological problems (26.5; 95% CI, 23–30). The rate of referrals was 18.3 per 100 encounters (95% CI, 16–21). Conclusions: The three clinics providing services to asylum seekers in Melbourne are delivering care to a considerable number of people with complex health needs. A substantial number of asylum seekers present to clinics with psychological and social problems. Most cannot access government-subsidised health care. This must be addressed urgently by policy change at the federal and state and territory levels.

Advocacy for health : revisiting the role of health promotion

Issue addressed: The importance of advocacy in protecting the population’s health; and suggested strategies to advance an advocacy role. Discussion: This article explores the concept of health advocacy, discusses an example of successful health advocacy within Australia, and outlines and addresses some of the barriers to advocacy. It aims to encourage discussion on advocacy’s potential to improve the public’s health. Conclusions: Many of the major successes of health promotion have been facilitated through the efforts of advocates. This article supports the proposition that advocacy is a fundamental instrument of health promotion practice and suggests strategies to apply these principles in practice.

Evaluation in health outcomes research : linking theories, methodologies and practice in health promotion.

Health outcomes research has developed as a means of evaluating the effectiveness of health care interventions and as an approach to informing resource allocation. The use of a health outcomes approach in health promotion has made increasing demands on evaluation methodologies to demonstrate program effectiveness. However, criticism of the contribution of health promotion to outcomes research has made several assumptions about the use of qualitative methodologies and the content of program objectives largely derived from a biomedical approach. In contrast to the measurement of biomedical interventions in clinical health care, health promotion practice involves social phenomena, wide-reaching cultural, psychological, political and ideological problems and issues. The integration of methodologies of health promotion evaluation will inform further conceptualisation of the health outcomes approach with the differentiation of three types of outcomes: health development outcomes; social health outcomes; and biomedical health outcomes. It is concluded that this differentiation moves away from dualist concepts that advocate the replacement of goals and targets with regional and locally based approaches. Rather, the future direction for health promotion evaluation needs to employ a framework that elaborates multiple methodologies and approaches necessary for establishing what relationships exist between morbidity, mortality, health advancement and equity.

Communicating personal amnesty : a model for health promotion in an Australian disability context

Currently pathological and illness-centric policy surrounds the evaluation of the health status of a person experiencing disability. In this research partnerships were built between disability service providers, community development organizations and disability arts organizations to build a translational evaluative methodology prior to implementation of an arts-based workshop that was embedded in a strengths-based approach to health and well-being. The model consisted of three foci: participation in a pre-designed drama-based workshop program; individualized assessment and evaluation of changing health status; and longitudinal analysis of participants changing health status in their public lives following the culmination of the workshop series. Participants (n = 15) were recruited through disability service providers and disability arts organizations to complete a 13-week workshop series and public performance. The study developed accumulative qualitative analysis tools and member-checking methods specific to the communication systems used by individual participants. Principle findings included increased confidence for verbal and non-verbal communicators; increased personal drive, ambition and goal-setting; increased arts-based skills including professional engagements as artists; demonstrated skills in communicating perceptions of health status to private and public spheres. Tangential positive observations were evident in the changing recreational, vocational and educational activities participants engaged with pre- and post- the workshop series; participants advocating for autonomous accommodation and health provision and changes in the disability service staff's culture. The research is an example of translational health methodologies in disability studies.

Design and ethics in digital mental health promotion

This chapter presents a case study of Participatory Design as a design framework for developing interactive digital tools for promoting children’s resilience. The author argues for a participatory methodology as an ethical approach that involves children as co-designers in the process from which they are traditionally excluded, namely the creative design process and the process of mental health promotion.

"But we’re already doing it!" Examining conceptual blurring between health promotion and palliative care

Over the past decade, an increasing number of palliative care service providers have attempted to integrate health promotion into their organisational practice. A key factor in the success of this endeavour has been the recognition by these providers of the conceptual ‘fit’ between two seemingly disparate approaches to health care. When informed of the elements of health promotion, palliative care professionals have expressed their recognition in their declaration: ‘But we’re already doing it!’ (Rosenberg 2007). Yet it appears that this association between the two suggests that health promotion in palliative care organisations is being understood in poorly defined ways. ‘Health promotion’ can be incorrectly assumed to be synonymous with ‘health education’; ‘death education’ can be understood to be synonymous with providing information about palliative care resources. Whilst these activities may be worthwhile within themselves, their presence in the activities of an organisation does not constitute the practice of health promoting palliative care (HPPC) (Kellehear 1999)...

Health promotion

Subheadings: What is health promotion? Research and health promotion practice Planning and evaluation as the cornerstones of evidence

Health promotion for dogs and humans : the 10,000 steps Rockhampton dog walking intervention

Purpose This paper describes the implementation and evaluation of an intervention aimed at increasing the dog-walking behaviour of residents from a community of approximately 60,000. This intervention was a sub strategy of the 10 000 Steps Rockhampton project – a community intervention aimed at decreasing sedentary behaviour in the adult population. Methods Brochures and posters were developed that promoted dog walking as a means to improve both human and canine health. The brochures were distributed by the local council to over 8 000 homes with the annual dog-renewal registrations. Results Evaluation of the intervention included a telephone survey of a randomly selected sample of Rockhampton residents (n=420) four-months post intervention. Although 63.6% of participants reported that owning a dog increased their physical activity levels, 40% of dog-owners did not walk their dog at all in the last week. The outcome evaluation of the intervention showed that 20.2% of dog-owners recalled receiving the brochure. Overall 15.3% of respondents with a dog in their household reported an increase in their physical activity levels since the intervention, 8.4% reported a decrease. Conclusions The intervention was an innovative and cost-effective way to tap into a section of the population that can benefit from engaging in regular walking behaviour. It was also a unique and useful way to engage local council in physical activity health promotion as part of a larger ongoing community-wide intervention.

Deadly Choices or deadly choices? An ethnography of health promotion practice with Indigenous Australians

This presentation provides an overview of my PhD research, which links with the Institute for Urban Indigenous Health (IUIH) and its Deadly Choices team. In the presentation, I introduce my critique of mainstream health promotion practice, highlighting the need for decolonisation of health promotion and the opportunity to learn from health promotion practice that acknowledges Indigenous knowledge, skills and perspectives. I also overview my ethnographic research methodology, which enabled me to be a participant observer with IUIH health promotion practitioners. I canvas some of my findings to date, according to two key areas: the unique way Deadly Choices applies leadership as its model of health promotion practice; and the range of innovative engagement strategies they employed, including the Deadly Choices brand and social media. I conclude by highlighting the counter-narrative and contrast that Deadly Choices provides compared to traditional health promotion approaches with Indigenous people, and identify lessons for decolonisation of heath promotion more broadly.

Deadly Choices : better ways of doing health promotion

Editor's introduction: Mainstream health promotion has failed Aboriginal and Torres Strait Islander peoples, according to Karen McPhail-Bell, a PhD candidate at Queensland University of Technology. In the article below, she argues that those working in the field could learn from strengths-based programs like The Institute for Urban Indigenous Health’s Deadly Choices. It offers lessons for all health promotion practice, she says. Her challenge is timely, with the Public Health Association of Australia’s 43rd annual conference starting in Perth tomorrow (follow #PHAA2014 for Twitter news from the conference).