+
Health Promotion - Settings Approach and Policy Development

Health Promotion - Settings Approach and Policy Development

Author: Lyneene Orsini
See More
Try a College Course Free

Sophia’s self-paced online courses are a great way to save time and money as you earn credits eligible for transfer to over 2,000 colleges and universities.*

Begin Free Trial
No credit card required

25 Sophia partners guarantee credit transfer.

221 Institutions have accepted or given pre-approval for credit transfer.

* The American Council on Education's College Credit Recommendation Service (ACE Credit®) has evaluated and recommended college credit for 20 of Sophia’s online courses. More than 2,000 colleges and universities consider ACE CREDIT recommendations in determining the applicability to their course and degree programs.

Tutorial

Online Class Instructions

You need to work through the online tutorial at your own pace. Completing both the readings and the student activities.

Please open up a blank word document and complete the student activities on this once completed email through to your tutor

Introduction

 

One of the basic principles of the Ottawa Charter, involves development of healthy public policy, which can include things like new regulations, eg smoking on public transport, guidelines eg hygiene standards and legislation eg tax on cigarettes, drink driving laws and novice driver licensing. Another principle of the Charter talks about healthy settings which can mean organisational settings eg schools, hospitals, and other workplaces, or this can be as large as large as healthy cities.

 

Richards (1999: 1592) reported on a meeting of international experts organised by the Office of Health Economics, London that concluded:

 

“Spending more money on health care and ways to change individual’s behaviour is unlikely to have as much effect as investing in policies that promote sustainable development, protect the environment, promote equity and tackle the social gradient of health”.

Changing Behaviours

 

An example from Eggar, Spark and Lawson of the so called ecological model for changing behaviour would for instance ask the question “What makes people obese?” answers to which would include access to food, choice of food, cooking skills, etc. The intervention would include working on changing the fat content of food at the source of production rather than only raising awareness about the fat content of food, offering healthy alternatives in school canteens and in child care facilities because this is when eating habits are developed, also working.

 

Clearly this approach is all-inclusive, involving individuals, local groups and communities, but also intersectoral (note the spelling please) involving agencies and government at all levels and not just health people. As Milio put it way back in 1981, the intervention aims to:

“… make the healthy choice the easy choice,  or in the case of legislation –the only choice.”

 The three key approaches outlined for focus on populations: policy, organisations and the environment will be reviewed briefly in turn

Health Public Policy

 

Palmer and Short (2010: 23) defined policy as:

“a course of action of government… a general statement of intention. a set of actions by government over a period…..or a set of standing rules.”

 

WHO is encouraging the building of healthy public policy because it creates a supportive environment and makes it easier to choose healthy options. It has wider impact than individual projects. According to WHO at the Adelaide Conference 1988:

“Healthy public policy is the policy challenge set by a new vision of public health. It refers to policy decisions in any sector or level of government that are characterised by an explicit concern for health and accountability for health impact. It is expressed through horizontal strategies such as intersectoral collaboration and public partnerships”.

Policy Change

 

Often policy changes are gradual eg no smoking policy in Australia was initially in government department offices only and voluntary elsewhere. As this gradually got accepted it was made enforceable for public transport, pubic buildings, restaurants and soon clubs and pubs. 

A range of examples follows:

·      Tree planting to reduce noise and lead pollution. Now landscaping of developments and new roads is legislated.

·      Building codes eg balcony construction.

·      Standards Australia codes eg cot sides.

·      Fire arms legislation.

·      Provision of public housing.

·      OH&S legislation.

·      Welfare payments.

Health and Food inspections and hygiene standards

Environmental Change

for environmental changes, think about how risk conditions can be changed. It’s about physical, social, economic and political change. It’s about those environmental conditions that can influence health or harm health, especially for the disadvantaged. It’s also about the need for policies that can modify these influences on health. Examples include immunisation, fluoridation, no hats no play policy for schools, safety glasses, machine guards, noise protection, even simple advice to turn down hot water tank temperatures, which has now been legislated in some countries for new appliances so that the temperature is preset.

Student Activity 1

 

Go to the WHO regional Office for Europe website: http://www.who.int/healthy_settings/types/cities/en/index.html Then search for healthy cities in their search engine- its a long link!

 

  1. What is a healthy city?
  2. What is the healthy cities approach?
  3. Name three healthy city projects in Australia. 

Student Activity 2

 

Download:

Yeatman, H. R. and Nove, T. (2002) Reorienting health services with capacity building: a case study of the Core Skills in Health Promotion Project. Health Promotion International, 7: 341-350.

http://heapro.oxfordjournals.org/content/17/4/341.abstract

 

Harpham, T., Burton, S. and Blue, I. (2001) Healthy city projects in developing countries: The first evaluation. Health Promotion International, 16: 111-125.

http://heapro.oxfordjournals.org/content/16/2/111.long

 

  1. What problems have been identified with re-orienting the setting of health services?
  2. What were the main activities selected in developing countries’ healthy cities projects? What worked and what problems were identified?

 

Organisation Change Theories

 

1.     Awareness raising especially with senior staff by clarifying health related problems in the organisation and convincing people of the importance of the issues.

2.     Adoption, meaning involvement in planning for adoption of policy, programs or interventions to address problems, includes resource allocation with some change of ideas so they work for the local conditions.

3.     Implementation or delivery including training, development of material, resource support and capacity building.

4.     Institutionalisation or long-term maintenance of an innovation- or in my words:  setting it in concrete!

Intersectoral development

 

Intersectoral development is about planning, making allies, networking and doing deals or negotiating according to Ewles and Simnett (2004). It’s about using power and influence whether expert, position, resource or personal power for the greater good. They list some of the strategies that are used when challenging health-damaging policies including:

·      Investigating and communicating about local issues eg local paper articles on no plastic bags.

·      Political lobbying of local MPs and heads of government departments.

·      Letter writing eg standard letters to protest about issues.

·      Community development.

·      Awareness raising eg media, lectures, articles in papers, festivals, competitions.

·      Demonstrations eg clean up Australia Day or more angry protest as seen in Green Peace actions.

·      Increasing community capacity- see the NSW health website documents on capacity building and examples of actions taken- as listed under publications.

·      Responding to calls for community input or government enquiries.

·      Establishing advocacy groups.

·      Community representation on committees.

·      Using unions and professional associations for input to health issues. 

Health Environment

 

Public health actually started in local government and this is where the most significant gains in health have been made from such actions as ensuring clean water, waste disposal (garbage and sanitation) and clean air. Furthermore, the social environment was also an early cause for concern eg child labour, working conditions and poor housing.  The growing gap between rich and poor is another theme explored in this approach. As Labonte back in 1991 stated, cited in Naidoo and Wills 2004: 109, people operate in an ecological system in which economic, environmental and social factors are inter-connected.

 

 Underlying this ecological model is the concept of sustainable development, as defined in the Brundtland Report of 1987 also cited in Naidoo and Wills, 1998:

“development which meets the needs of the present without compromising the ability of the future generations to meet their own needs.”

Student Activity 3

 

Go to UWS Library search box and access the following article: Lowe, I. (2002) Ecological health promotion: Some principles: What does sustainability mean? Plenary address to the Australian Health Promotion Association. Conference (2001: Gold Coast).]  Health Promotion Journal of Australia, 13(1):5-9. 

 

  1. Why does the goal of reducing poverty NOT follow inevitably from economic development?
  2. Why is Australian development NOT sustainable? 

http://search.informit.com.au/fullText;dn=456924388997735;res=IELHEA

Kyoto Convention

 

Probably the biggest ecological example is the Kyoto Convention, to which Australia did not a have a significant commitment, until the Rudd government came into power.  In fact, when signatory nations agreed to reduce emissions the previous Australia government actually allowed an 8% increase as shown in the next table! The major distinction between the Protocol and the Convention is that while the Convention encouraged industrialised countries to stabilise GHG emissions, the Protocol commits them to do so. 

Student Activity 4

 

Go to the Kyoto protocol website: http://unfccc.int/kyoto_protocol/items/2830.php

  1. What is the Bali Road map? 

Student Activity 5

 

You have just been voted in as the council of Sun City with an over whelming majority, on a healthy environment platform, covering:

  • Healthy public policy.
  • Creating healthy settings eg the physical environment, transport, housing, schools and health care settings, also Healthy Cities.
  • A healthy environment

 

TASKS

1. What will you do to address the typical urban fringe new city health issues that might be encountered? Some policy examples are attached. Come up with healthy city projects for this new city. Consider funding and policy or legislative options.

2. How will you ensure community support and participation?

3. What other stakeholders would you need to involve in making projects intersectoral? Examples attached of strategies.

4. How will Council ensure that development is sustainable?

 

Policy changes are often gradual eg no smoking policy.

Examples:

·      Tree planting.

·      Fire arms legislation.

·      Technological changes eg child restraints, safety latches, child proof packaging, and enviro. changes

·      Building and Standards Australia codes eg balcony construction, cot sides.

·      Provision of public housing, Welfare payments

·      OH&S legislation.

·      Health and Food inspections, hygiene standards.

·      Immunisation.

·      Fluoridation.

·      No hats no play policy for schools.

·      Safety glasses, machine guards, noise protection.

·      Even simple advice to turn down hot water tank temperatures.

·      Mandatory fire alarms in private housing etc.

 

Intersectoral development

Planning, making allies, networking and doing deals or negotiating according to Ewles and Simnett. It’s about using power and influence whether expert, position, resource or personal power for the greater good.

Strategies that are used when challenging health-damaging policies include:

·      Investigating and communicating about local issues eg local paper articles on no plastic bags.

·      Political lobbying of local MPs and heads of government departments.

·      Letter writing eg standard letters to protest about issues.

·      Community development.

·      Awareness raising eg media, lectures, articles in papers, festivals, competitions.

·      Demonstrations eg clean up Australia Day or more angry protest as seen in Green Peace actions.

·      Increasing community capacity

·      Responding to calls for community input or government enquiries.

·      Establishing advocacy groups.

·      Community representation on committees.

·      Using unions and professional associations for input to health issues.

Once an intervention or demonstration project has been funded it’s about ensuring continuation or sustainability.