health promotion uk essay

Health Promotion in Modern Society Essay

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As the post shows, today, health promotion is becoming vital. Health and community wellbeing are defined by a variety of elements outside the health system, such as socioeconomic conditions, styles of food consumption, demographic trends, family dynamics, learning environments, and the societal and cultural fabric of societies. These factors also include economic changes, such as those related to trade and commercialization, as well as environmental changes on a global scale. Health issues in such a situation can be addressed by taking a holistic approach that encourages governance for public health, empowers people and communities to take charge of their health, promotes intersectoral activity to create healthy regulations in all sectors, and fosters the development of sustainable health systems.

The post sheds some light on the concept of health empowerment. In the same vein, I would also add and highlight the importance of community empowerment which gives groups of people more authority over their own lives. Empowerment is the process through which people take charge of the elements and choices that mold their life. It is how people develop their capacities to obtain access, allies, networks, and a voice to take control. ‘Empowering’ suggests that people can only ’empower’ themselves by acquiring more of the various forms of power; they can never ‘be empowered’ by others. Similarly, the post notes that health promotion is demonstrated by the sensation of responsibility over one’s own life and the desire to maintain one’s health.

Finally, the post mentions primary care physicians who engage in lifestyle counseling with their patients. I find it an especially useful theme to discuss as interventions designed to influence behavior are frequently intricate and comprised of various elements. I agree with the post regarding the necessity of conducting additional research on the promotion of health care. The reason is that relatively few scientific analyses concentrate on lifestyle modifications despite mounting evidence of their efficacy in lowering health risks.

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103 Health Promotion Essay Topic Ideas & Examples

Inside This Article

Health promotion is a crucial aspect of public health that aims to improve the overall well-being and health of individuals and communities. This can be achieved through various strategies, such as education, advocacy, and policy changes. If you are tasked with writing an essay on health promotion, you may be looking for some inspiration on potential topics. To help you get started, here are 103 health promotion essay topic ideas and examples:

• The impact of social determinants of health on health promotion efforts
• Strategies for promoting physical activity in children
• The role of the healthcare system in health promotion
• The effectiveness of workplace wellness programs
• Promoting healthy eating habits in schools
• Addressing mental health stigma through education and advocacy
• The importance of community partnerships in health promotion
• Promoting smoking cessation programs in underserved communities
• The impact of social media on health promotion campaigns
• Promoting sexual health education in schools
• Strategies for addressing obesity in children and adolescents
• Promoting healthy aging through exercise and nutrition programs
• The role of technology in health promotion efforts
• Promoting vaccination campaigns to prevent infectious diseases
• Addressing substance abuse through education and prevention programs
• The impact of environmental factors on health promotion
• Promoting healthy sleep habits in adolescents
• Strategies for promoting mental health and well-being in the workplace
• The role of policy changes in promoting public health
• Promoting access to healthcare services for underserved populations
• Addressing disparities in healthcare access through health promotion efforts
• Promoting healthy lifestyle choices in college students
• The impact of stress on health and strategies for stress management
• Promoting mindfulness and meditation as tools for improving mental health
• Strategies for promoting physical activity in older adults
• Addressing food insecurity through community-based interventions
• Promoting reproductive health education in schools
• The impact of cultural beliefs on health promotion efforts
• Promoting health literacy in vulnerable populations
• Addressing the opioid epidemic through education and prevention programs
• Promoting access to mental health services in rural communities
• Strategies for promoting healthy relationships and preventing domestic violence
• The impact of social isolation on health and well-being
• Promoting nutrition education in low-income communities
• Addressing the impact of climate change on public health through health promotion efforts
• Promoting smoking cessation programs in pregnant women
• Strategies for promoting physical activity in individuals with disabilities
• The role of peer support in promoting mental health and well-being
• Promoting access to reproductive health services for LGBTQ+ individuals
• Addressing the impact of trauma on health through trauma-informed care
• Promoting access to mental health services for veterans
• Strategies for promoting healthy eating habits in low-income communities
• The impact of social media influencers on health promotion campaigns
• Promoting access to healthcare for homeless populations
• Addressing the impact of food deserts on nutrition and health
• Promoting access to mental health services for immigrant populations
• Strategies for promoting physical activity in individuals with chronic illnesses
• The impact of peer pressure on health behaviors and strategies for resistance
• Promoting access to reproductive health services for incarcerated individuals
• Addressing the impact of social isolation on older adults through community programs
• Promoting healthy aging through social engagement and support networks
• Strategies for promoting mental health and well-being in the LGBTQ+ community
• The impact of trauma on health outcomes and strategies for healing
• Promoting access to mental health services for individuals with substance use disorders
• Addressing the impact of poverty on health through social determinants
• Promoting healthy eating habits in refugee communities
• Strategies for promoting physical activity in children with autism
• The impact of social support on health and well-being
• Promoting access to healthcare for individuals experiencing homelessness
• Addressing the impact of racism on health outcomes through anti-racism efforts
• Promoting mental health awareness and reducing stigma in communities of color
• Strategies for promoting physical activity in individuals with intellectual disabilities
• The impact of trauma on mental health and strategies for healing and recovery
• Promoting access to mental health services for survivors of domestic violence
• Addressing the impact of childhood adversity on health through trauma-informed care
• Promoting reproductive health education in communities with high rates of teen pregnancy
• Strategies for promoting physical activity in individuals with chronic pain
• The impact of social support on mental health outcomes
• Promoting access to mental health services for individuals with eating disorders
• Addressing the impact of discrimination on health through anti-discrimination efforts
• Promoting healthy eating habits in communities with limited access

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PHE Strategy 2020 to 2025

This strategy sets out Public Health England's priorities for the next 5 years.

PHE Strategy 2020 to 2025: executive summary

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The PHE Strategy 2020 to 2025 sets out how Public Health England will work to protect and improve the public’s health and reduce health inequalities over the next 5 years.

It outlines PHE ’s role within the public health system, 10 priorities where PHE will focus particular effort and the areas where PHE will build capability within the organisation to support delivery of its strategic objectives and wider activities.

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Health promotion

“Health promotion is the process of enabling people to increase control over, and to improve their health.” Health Promotion Glossary, 1998

 A brief history of Health Promotion

The first International Conference on Health Promotion was held in Ottawa in 1986, and was primarily a response to growing expectations for a new public health movement around the world. It launched a series of actions among international organizations, national governments and local communities to achieve the goal of "Health For All" by the year 2000 and beyond. The basic strategies for health promotion identified in the Ottawa Charter were: advocate (to boost the factors which encourage health), enable (allowing all people to achieve health equity) and mediate (through collaboration across all sectors).

Since then, the WHO Global Health Promotion Conferences have established and developed the global principles and action areas for health promotion. Most recently, the 9th global conference (Shanghai 2016), titled ‘Promoting health in the Sustainable Development Goals: Health for all and all for health’, highlighted the critical links between promoting health and the 2030 Agenda for Sustainable Development. Whilst calling for bold political interventions to accelerate country action on the SDGs, the Shanghai Declaration provides a framework through which governments can utilize the transformational potential of health promotion.

Promoting Healthier Populations 

 The Sustainable Development Goals (SDGs) provides a bold and ambitious agenda for the future. WHO is committed to helping the world meet the SDGs by championing health across all the goals. WHO’s core mission is to promote health, alongside keeping the world safe and serving the vulnerable. Beyond fighting disease, we will work to ensure healthy lives and promote well-being for all at all ages, leaving no-one behind.

Our target is 1 billion more people enjoying better health and well-being by 2023. 

• Good Governance

Strengthen governance and policies to make healthy choices accessible and affordable to all, and create sustainable systems that make whole-of-society collaboration real. This approach is based on the rationale that health is determined by multiple factors outside the direct control of the health sector (e.g. education, income, and individual living conditions) and that decisions made in other sectors can affect the health of individuals and shape patterns of disease distribution and mortality.

• Health Literacy

Improving health literacy in populations provides the foundation on which citizens are enabled to play an active role in improving their own health, engage successfully with community action for health, and push governments to meet their responsibilities in addressing health and health equity.

• Healthy Settings

The settings approach has roots in the WHO Health for All strategy and, more specifically, the Ottawa Charter for Health Promotion. Healthy Settings key principles include community participation, partnership, empowerment and equity. The Healthy Cities programme is the best-known example of a successful Healthy Settings programme.

• Social mobilization

Bringing together all societal and personal influences to raise awareness of and demand for health care, assist in the delivery of resources and services, and cultivate sustainable individual and community involvement.

• Health literacy
• What is health promotion?
• Initiative on urban governance for health and well-being
• Achieving well-being: a draft global framework for integrating well-being into public health utilizing a health promotion approach (WHA 76/A76/7 Add.2)
• Well-being and health promotion (WHA75.19)
• Contributing to social and economic development: sustainable action across sectors to improve health and health equity (WHA 67)
• Reducing health inequities through action on the social determinants of health (WHA 62.14)
• Contributing to social and economic development: sustainable action across sectors to improve health and health equity (follow-up of the 8th Global Conference on Health Promotion) (EB134)
• Health Promotion  

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Healthy Cities: Urban governance for health and well-being, examples from Swiss cities

Healthy cities: urban governance for health and well-being, examples from swiss cities (short).

Alcohol consumption webinar: Warnings at the World Trade Organization"

Make Every School a Health-Promoting School: a call by WHO's Director-General, Dr Tedros

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Health Promotion in the UK

Info: 5447 words (22 pages) Nursing Essay Published: 11th Feb 2020

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Societies construct patterns of behaviour by deeming certain actions or speech as acceptable or unacceptable. These patterns of behaviour within a given society are known as societal norms. Societies, and their norms, undergo gradual and perpetual changes.

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Public Health Issue of Smoking

Info: 6268 words (25 pages) Dissertation Published: 13th Dec 2019

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Tagged: Health Public Health

The aim of this essay is to analyse the public health issue of smoking, which has major effects on the health of society and individuals within the adult population in England and Wales. Using evidence from a variety of sources including seminal texts, it will look at the cost to the NHS (National Health Service) and the policies that have been put in place by the government to address the issues surrounding tobacco use. It will also examine how the role of the nurse can promote healthy lifestyles in order to improve the health of individuals and the community.

Tobacco use is seen as the leading cause of preventable mortalities in adults aged thirty-five and over worldwide. In the UK (United Kingdom), as of 2017, there were over 7.4 million adult smokers (Office for National Statistics, 2017), 16.1% of the population in Wales smoke with 1 in 5 mortalities attributed to smoking (Welsh Government, 2012) and 14.9% of the population in England with tobacco use causing around 17% of the mortalities (Public Health England, 2015). The cost to the NHS for smoking-related illnesses in England was £2.6 billion in 2015 (Public Health England, 2017), in Wales it was £386 million in 2012/13 (Public Health Wales, 2013).

Public Health is described as the science of protecting and promoting healthy lifestyles and the well-being of individuals and their communities, to change their behaviours. This is achieved through the efficiency and organised efforts of the governments and local communities, working with individuals to make informed choices in order to minimise the risk of disease, ill health and to prolong life. (Naidoo & Wills, 2016; Scriven, 2017).

This is attained through health promotion, to work with communities and individuals to have more control in promoting and improving aspects of their health. Health promotion focuses not only on the individual but also on the social and environmental factors that affect the health and well-being of individuals to enable them to have a quality of life (World Health Organization (WHO), 1986).

Health promotion has an important role in public health. Its function is to support, empower and enable individuals and their communities to become more aware of lifestyle behaviours, in order to improve health and well-being (Scriven, 2017). This is achieved by educating communities and targeting individuals, who are considered at high risk of developing conditions that could affect their health (Naidoo & Wills, 2016). Nurses have an important role in public health and have a duty of care to prevent illness and protect the health of communities through health promotion. It is a fundamental skill of an adult nurse, in the healthcare setting to use their knowledge and skills to promote well-being, providing choice, while working in conjunction with the population, and other healthcare professionals to educate individuals on how to maintain their health, therefore prolonging life (Royal College of Nursing (RCN), 2016).

In accordance with the Nursing and Midwifery Council (NMC) The Code (2015), all names and locations have been changed in order to ensure patient confidentiality.

Smoking tobacco has been deemed as one of the leading health concerns in the world. It is believed to be the primary cause of many illnesses and the highest cause of preventable mortalities in the UK (Grant, 2017).

Tobacco use has accounted for almost 78 thousand preventable mortalities that occurred in England in 2016 and over five thousand five hundred mortalities in Wales every year (Office for National Statistics, 2017).

It is thought there are over four thousand different chemicals found in tobacco smoke, including tar, nicotine, benzene and ammonia. Of these four thousand chemicals, more than fifty are said to cause cancer (ASH, 2014).

That being said, the Centre of Disease Control and Prevention (CDC) agree that smoking is linked to a number of serious health issues such as lung cancer, chronic obstructive pulmonary disorder (COPD) and illnesses concerned with the cardiovascular system. Along with other organs in the body that could prematurely cause the death of half of the lifelong smokers (Centres for Disease Control and Prevention, 2018). The WHO concur with this information, confirming that people who smoke at least a packet of cigarettes a day are reducing their lives by at least seven years compared to those who don’t smoke (Da Costa e Silva, 2003).

As of 2017, there is around 15.1% of the population, that’s 7.4 million people who smoke in the UK, with Wales having 16.1% of smokers, this is equivalent to 386 thousand people. England currently has the lowest percentage of smokers with 14.9%, equivalent to 6.1 million people (Office for National Statistics, 2017). In 2010 both England and Wales had 25% of their population smoking, when the information is compared to 2017 it shows the prevalence of tobacco use has decreased by 8.9% in Wales and 10.1% in England (Public Health Wales Observatory & Welsh Government, 2012 & Office for National Statistics, 2017).

Studies have also shown that men are still more likely to smoke than women (National Institute on Drug Abuse, 2018). This could be due to the fact that more men among the unskilled manual workers, use tobacco to obtain the effects of the nicotine, by activating the reward pathway when they smoke (Graham, Jefferis, Manor, Power, 2004). Whereas women are less likely to do manual labour and more likely to do office work, where smoking is seen as a social disapproval (Fong & Hitchman, 2011), however, Women are given a false belief that smoking assists them to lose weight and with increasing numbers of women working in male-dominated occupations, receiving pressure from the job causes them to suffer from mental health conditions (Gardiner & Tiggemann, 2010), and smoke as a way to relieve stress and regulate mood (National Institute on Drug Abuse, 2018). In some countries, however, women are being empowered to smoke, thus closing the smoking rates between men and women (Fong & Hitchman, 2011).

In 2010 in the UK it can be seen the smoking population was made up of 21% of men and 20% of women who smoked, when this is compared to 2016 it shows the prevalence of smokers has decreased to 17.7% of men and 14.1% of women, ASH, 2017).

Since the smoking ban came into force in 2007, the cost of a packet of cigarettes has increased from £5.33 to a staggering £9.91, making the annual cost to the individual who smokes 20 a day, over £3500 (Statista, 2018). With the cost of cigarettes increasing, the prevalence of tobacco use has declined, with people more willing to quit and choose a healthier lifestyle. However, despite the downward trend of smokers, 39% of children are still being exposed to second-hand smoke (Welsh Government, 2012).

Even with the decline in smokers, the cost to NHS England in 2015 was £2.6 billion, with over 520 thousand admissions into a hospital from smoking-related illnesses in 2015/16 in adults over 35 years old (Public Health England, 2015). However, while the NHS cost is high for tobacco-related illnesses, it can be argued that the government in the 2017/18 financial year made over £8,827 million from the duty paid on cigarettes, profiting from people who smoke, therefore if the UK was to become smoke free, the country would be worse off financially (Dickson & O’Kane, 2018).

While across the border in Wales the cost to the Welsh NHS was £302 million in 2017. This is a result of 26489 smoking-attributable admissions into hospital, placing a significant burden on the Welsh NHS services (Public Health Wales Observatory, 2017). This does not include the cost to the Welsh government. Their cost is a staggering £790 million every year as a consequence of smoking-related fires, in homes and businesses, clearing up cigarette ends from the streets and also absences from work which have resulted in an estimated 1 million days that are lost. (Grant, 2017).

This also costs businesses approximately £8.7 billion a year, due to lost productivity, as a result of the number of smoking breaks and absences taken due to smoking-related illnesses (Centre for Economics and Business Research, 2014). To reduce the amount of days that are lost due to absences and improve productivity, the employer could support the employee to quit smoking (Healthy Working Wales, 2018), by encouraging them to attend smoking cessation support sessions without the loss of pay and also promote the employees to participate in no smoking days (Healthy Working Wales, 2018). This could save a company up to four thousand pounds a year as a result of less sickness and employees having shorter breaks (Healthy Working Wales, 2018).

Looking at the local health board area, tobacco use has decreased in the ABMU ( Abertawe Bro Morgannwg University Health Board ) area from 23% in 2013/14 to 19% in 2015. This result is a promising start showing the prevalence of tobacco use is falling and ABMU is on target to reach 16% of smokers by 2020 (Newbury Davies, 2017).  It is also said 22% of the population in Swansea are currently smoking with the lowest rate in Cardiff with 14%.

Even though the prevalence has fallen, it is believed that smoking has risen in the unemployed by 2%, (ASH Wales, 2018) possibly as a result of psychosocial factors. Suggesting those who smoke are affected by the stress, low self-esteem, and financial issues of being unemployed (Santinello & Vogli,2005). This epidemiology data does not provide an accurate account of current smokers but it does allow us to identify important information in the health of the population. However, it only provides part of a picture and consideration needs to be given to the socio-economic and environmental factors that affect the health of the individual and communities (Scriven, 2017).

Socio-economic and environmental factors known as determinants of health such as education, employment, housing and social status are said to have an influence on the health of both the community and individual (Matthews, 2015). With tobacco use is said to be linked to the different socio-economic groups, being at least four times higher in the most deprived areas in the UK than the most affluent areas. It is also said that the social and economic inequality in social classes is one factor that determines the increasing variation of life expectancy between classes (Amos, Bauld, Hiscock, & Platt, 2012).

It can be argued that people in the lower social groups living in the deprived areas of the UK, where they may have insecurities from low income, mental health or even homelessness are more at risk of smoking as a way of dealing with their concerns (Matthews, 2015). Therefore, being at higher risk of stroke or heart disease which will have a detrimental effect on their health and well-being (Kozier et al., 2012).

Tobacco use in 2017 was found to be higher in the unemployed with 29% compared to 15.5% of employed people (Office for National Statistics, 2017). However, this could be due to a decline in the employed people smoking, whereas the unemployed there is only a slight decline (Amos et al., 2012). It also found that the people from the lower class who were employed in routine and manual occupations such as lorry drivers, care workers and bar staff, accounted for 25.9% of the smokers in the UK. This, however, could be as a result of the lower class smoking habit, having the opportunity to smoke and peer pressure (Coleman & Sherriff, 2012) While those in the higher classes working in managerial and professional occupations such as teachers, lawyers and nurses have accounted for 10.2% of smokers. This shows that there is a significant difference between the higher and lower echelons of the working class, with the lower echelons twice as likely to smoke (Office of National Statistics, 2017).

Social inequality in health can also be explained further by other risk factors in the lifestyle and behaviours of individuals. These include the lack of physical exercise and the number of unhealthy foods that are eaten. Even though these are considered to be common lifestyle choices in the socio-economically worse off and can be attributed to serious health issues such as cardiovascular disease,  (Marchman Anderson, Oksbjerg Dalton , Lynch , Johansen , & Holtug , 2013). It can be argued that it is a result of the level of income they receive, with the more money they receive the better their health and well-being as they less likely to eat unhealthily, so will feel better in themselves and more likely to exercise (Rowlingson, 2011).

Social factors that could influence an individual to start smoking may exert from different routes, such as pressure from peers or groups of friends, where they all smoke, showing 19.7% of smokers are between the age of 25 to 34 years’ old (Office for National Statistics, 2017). Family members who may see smoking as part of a normal lifestyle, or even people exposed to misuse of drugs, alcohol and also stress therefore increasing the likelihood of the individual to start smoking (mental health Foundation, ND).

One of the main psychological factors that may account for individuals to choose to smoke as a lifestyle choice, maybe down to the individual having stress or even having mental health issues (Mental Health Foundation, ND). Once the individual has had that first hit of nicotine, it is said to improve their mood and concentration, especially if they are stressed. It is also said to decrease anger and suppress appetite (Mental Health Foundation, ND). The nicotine does, however, cause an addiction in the body, with regular smoking the dose of nicotine the body receives leads to changes in the brain. To function normally, the brain begins to rely on the nicotine, when individuals smoke they are exposed to the other chemicals, which can cause smoking-related conditions (Benowitz, 2017). When the individual attempts to quit smoking, the body doesn’t get the nicotine it’s come to rely on and the individual begins to experience withdrawal symptoms such as irritability, anxiety and increased appetite (Mental Health Foundation, ND). These factors can impact health inequalities, especially in the lower socio-economic group

In 2008, the WHO introduced a framework on the convention of tobacco control in the global population. It provided the world with six evidence-based control measures, aimed at reducing the use of tobacco in each country. These guidelines were known as (MPOWER), referring to (M) monitoring the use of tobacco and prevention policies, (P) protecting populations from tobacco smoke, (O) offering people programmes that help them to quit. (W) Warn the population of the risks, (E) enforce bans on advertising, sponsorship and promotion of tobacco use and (R) raise the taxes on tobacco products (WHO, 2015).

In 2013, the World Health Organisation (WHO) then put together a world tobacco target, with aims to reduce the number of smokers worldwide by 30%, in order to protect the next generation of people. This is a consequence of tobacco being the only legal drug that prematurely causes the mortality of at least 6 million smokers and non-smokers worldwide (WHO, 2015).

In light of this, the British government continue to aim for a tobacco-free country and following the guidelines from the WHO, the British government to date has banned television and tabloid advertising of tobacco products. They have also banned smoking in enclosed spaces, in an attempt to protect non-smokers from second-hand smoke (Department of Health and Social Care, 2015).  In 2016 the government made it law for all tobacco products to be sold in plain packets with pictures of the effects smoking has on the body and a strongly worded health warning, they also set high taxes on tobacco products in the hope to reduce the number of young adults and those on low incomes from smoking (Department of Health and Social Care, 2015).

The Welsh government is also wanting to improve the health of the communities and have taken some major steps to lower the number of Welsh smokers. They are striving to achieve this by setting laws to protect people. Since the smoking ban in 2007, where it was made illegal to smoke in enclosed spaces, air quality has improved and the exposure of second-hand smoke in adults has reduced (Malam, 2015).

In 2015 the Welsh government made it law for all shops to cover their displays of tobacco products and made it an offence to sell e-cigarettes to under eighteen, in the hope that by reducing the advertising of tobacco products, adults would be less likely to start smoking. It was also made illegal for adults to smoke in their cars whilst a child is present, reducing the risk of children being exposed to second-hand smoke (Welsh Government, 2017). This can be argued that the new policy is an invasion of privacy and infringed the rights of people’s freedom (Bain et al., 2014).

The Welsh government have produced a review of services aiming to achieve a smoke-free Wales and improve the health and well-being of the population. Working with seven local health boards, local governments and private sectors, all with the aim of improving the health and quality of life of individuals and communities, by providing services in areas that are deemed to be in most need (Public Health Wales Observatory, 2015).

Wales has goals to protect the well-being of future generations by providing a national framework that allows Wales to improve and grow as a nation and reduce the smoking population by 5% in the next four years, through the services currently available. Currently, the policies that are in place, aim to improve the quality of life and health of individuals in Wales (George, Griffiths, Tomlinson, Scholey & Williams, 2018).  However, these policies are designed to enable individuals who are at greater risk of health issues to choose and live healthy lifestyles. Our healthy future focuses on preventing ill-health by having a strategic plan which addresses issues such as social and environmental determinants, including housing, transport, education and exercise. To achieve this, commitment is needed from the public, private and third sectors (Public Health Wales Observatory, 2015).

To reduce health inequalities, it is imperative to target community areas that are most deprived, with smoking being a single factor that causes ill-health. It is important to reduce the number of individuals who use tobacco, this can be achieved through health promotion (Public Health Wales Observatory, 2015).

There are four behaviour change models in health promotion, that aim to change the behaviour of patients. These are the cognition model; focusing on the individual and how they think. Social cognition model; focuses on the influence others have on the individual’s behaviour. Empowerment; takes into account the difficulties individuals have to change their behaviour. However, these models are unlikely to work on their own, so Prochaska and DiClemente (1982) devised the trans-theoretical stages of change model, which incorporates the three other theories. (Evans, Coutsaftiki & Patricia Fathers, 2017).  It is believed individuals go through each stage when improving their lifestyles and can relapse at any time. These techniques enable health professionals to improve the success rate of individuals who quit smoking (Davies, 2011).

There are five stages to the model. Pre-contemplation; contemplation; preparation; action and maintenance. The task of the health professionals is to determine the readiness of the patient to change and assist them to move from one stage to another. It aims to educate and support people, hoping lifestyle choices and behaviours can be changed in order for them to lead a normal healthy life (Evans et al., 2017).

With six in ten people wanting to quit each year and some attempting to quit with no help, the Welsh government produced a number of initiatives that have been tailored to assist and motivate smokers to quit. These services have to be readily available to the public (Evans, 2017).

To provide these services, healthcare providers need to have good professional values, knowledge of various roles, responsibilities and also good patient-centred communication. This is fundamental if the patient is going to attempt behaviour change (Davies, 2011).

Utilising the skills in the framework developed by the public health and health and social care, which is based on Prochaska and DiClemente’s stages of change and also incorporating evidence-based practice to stop smoking, produced by NICE guidelines. Which has made recommendations that include providing behaviour support that is delivered by trained staff, nicotine replacement therapy and advice (National Institute for Health and Care Excellence, 2018). Which involves assessing the smoking behaviour of the patient past and present, provide information on the effects of smoking and not smoking, options for additional support and advice on medications (National Centre for Smoking Cessation and Training, 2018).

MECC (Making every contact count) aims to educate all NHS organisations in improving the health and well-being of the population (Making Every Contact Count, 2018). To bring together service and education providers along with individuals to change the systems and improve healthcare responsibilities, promoting all areas that affect the health and well-being such as psychological, socio-economic and environmental factors (Evans, 2017).

By adopting a systematic approach, working effectively in partnership with other organisations in the different sectors, focusing on individuals who are ill to improve their health and protect the population against potential ill-health, with the aim of improving the quality of health and reducing the life expectancies between classes (Department of Health, 2013).

Nurses have a major role in promoting healthy lifestyles, using day to day interactions that involve the local people to provide positive changes in their physical and mental well-being. They have the opportunity to improve nurse-patient interactions and engage with individuals and the communities, to change health behaviours and following the guidelines produced by MECC, they will be able to communicate in a way that encourages individuals to be open, acknowledging the individual’s rights to make their own decisions about their health.  Nurses will also gain the confidence and competence to provide advice that encourages behaviour change and direct patients to the appropriate services (Making Every Contact Count, 2018).

Services that are currently available in Wales are Stop Smoking Wales, currently supported by public health Wales. ABMU Health board have; Help Me Quit, this service provides one to one support over the phone and face to face. There are also eighty-four community pharmacies that have been trained to level 3, which allows them to support smokers in the most deprived areas (Newbury Davies, 2017). However, even though lower economic classes will use the stop smoking sessions, they may not completely stop, this could be due to the lack of motivation or having a stressful lifestyle, being nervous and depressed or have a lack of support outside the services, leading to smokers relapsing (George et al., 2018).

This essay has looked at the public health issue surrounding the use of tobacco, which is currently the leading cause of preventable mortalities in the UK and has had major effects on the health of society and also the individual. Having used evidence from a variety of sources, looking at costs to the NHS and local governments, the policies that are in place and what the nurse’s role is to promote healthy lifestyles.

This evidence showed that there is still 7.4 million people who use tobacco in the UK. Life expectancy is reduced by seven years for every packet of cigarettes smoked a day and over 50 cancer-causing chemicals found in the smoke of cigarettes. Individuals in the lower classes continue to smoke more than the affluent, being more common in men of the 25 to 34-year age group. This could be a result of social-economic and environmental factors, as smoking is seen to be linked to the unemployed, homeless and those who are socio-economically worse off, it can often be an attribute to other health conditions such as stroke and heart disease.

Smoking-related illnesses are currently costing the Welsh NHS £302 million a year with over 26 thousand admissions to hospital. However, it is also said that while costs for the NHS are high, the government is profiting from the sale of cigarettes.

Since the smoking ban in 2007 the prevalence of smokers has declined, with the government wanting to eradicate smoking, policies have been put in place to help smokers to quit and reduce the numbers of people starting to smoke. This is done with the hope that by reducing the number of smokers will reduce some of the inequalities and the life expectancy between classes will be minimised.

Services currently in place, like Help Me Quit and the 84 pharmacies are to aid the individual to become a non-smoker. By using a framework designed to assist in changing behaviour, nurses can support individuals in all areas, but mainly in the most deprived to provide motivation and support to change their lifestyle and improve their well-being.

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Health Promotion: An Effective Tool for Global Health

Sanjiv kumar.

International Institute of Health Management Research, New Delhi, India

Health promotion is very relevant today. There is a global acceptance that health and social wellbeing are determined by many factors outside the health system which include socioeconomic conditions, patterns of consumption associated with food and communication, demographic patterns, learning environments, family patterns, the cultural and social fabric of societies; sociopolitical and economic changes, including commercialization and trade and global environmental change. In such a situation, health issues can be effectively addressed by adopting a holistic approach by empowering individuals and communities to take action for their health, fostering leadership for public health, promoting intersectoral action to build healthy public policies in all sectors and creating sustainable health systems. Although, not a new concept, health promotion received an impetus following Alma Ata declaration. Recently it has evolved through a series of international conferences, with the first conference in Canada producing the famous Ottawa charter. Efforts at promoting health encompassing actions at individual and community levels, health system strengthening and multi sectoral partnership can be directed at specific health conditions. It should also include settings-based approach to promote health in specific settings such as schools, hospitals, workplaces, residential areas etc. Health promotion needs to be built into all the policies and if utilized efficiently will lead to positive health outcomes.

Introduction

Health promotion is more relevant today than ever in addressing public health problems. The health scenario is positioned at unique crossroads as the world is facing a ‘triple burden of diseases’ constituted by the unfinished agenda of communicable diseases, newly emerging and re-emerging diseases as well as the unprecedented rise of noncommunicable chronic diseases. The factors which aid progress and development in today's world such as globalization of trade, urbanization, ease of global travel, advanced technologies, etc., act as a double-edged sword as they lead to positive health outcomes on one hand and increase the vulnerability to poor health on the other hand as these contribute to sedentary lifestyles and unhealthy dietary patterns. There is a high prevalence of tobacco use along with increase in unhealthy dietary practices and decrease in physical activity contributing to increase in biological risk factors which in turn leads to increase in noncommunicable diseases (NCD).( 1 – 3 ) Figure 1 below illustrates how lifestyle-related issues are contributing to increase in NCDs.( 4 ) The adverse effects of global climate change, sedentary lifestyle, increasing frequency of occurrence of natural disasters, financial crisis, security threats, etc., add to the challenges that public health faces today.

Illustration of how lifestyle-related issues contribute to increase in noncommunicable diseases( 4 )

Health, as the World Health Organization (WHO) defines, is the state of complete physical, social and mental well being and not just the absence of disease or infirmity. The enjoyment of highest attainable standard of health is considered as one of the fundamental rights of every human being.( 5 ) Over the past few decades, there is an increasing recognition that biomedical interventions alone cannot guarantee better health. Health is heavily influenced by factors outside the domain of the health sector, especially social, economic and political forces. These forces largely shape the circumstances in which people grow, live, work and age as well as the systems put in place to deal with health needs ultimately leading to inequities in health between and within countries.( 6 ) Thus, the attainment of the highest possible standard of health depends on a comprehensive, holistic approach which goes beyond the traditional curative care, involving communities, health providers and other stakeholders. This holistic approach should empower individuals and communities to take actions for their own health, foster leadership for public health, promote intersectoral action to build healthy public policies and create sustainable health systems in the society. These elements capture the essence of “health promotion”, which is about enabling people to take control over their health and its determinants, and thereby improve their health. It includes interventions at the personal, organizational, social and political levels to facilitate adaptations (lifestyle, environmental, etc.) conducive to improving or protecting health.( 1 , 2 )

Health Promotion: Historical Evolution

Health promotion is not a new concept. The fact that health is determined by factors not only within the health sector but also by factors outside was recognized long back. During the 19 th century, when the germ theory of disease had not yet been established, the specific cause of most diseases was considered to be ‘miasma’ but there was an acceptance that as poverty, destitution, poor living conditions, lack of education, etc., contributed to disease and death. William Alison's reports (1827-28) on epidemic typhus and relapsing fever, Louis Rene Villerme's report (1840) on Survey of the physical and moral conditions of the workers employed in the cotton, wool and silk factories John Snow's classic studies of cholera (1854), etc., stand testimony to this increasing realization on the web of disease causation.

The term ‘Health Promotion’ was coined in 1945 by Henry E. Sigerist, the great medical historian, who defined the four major tasks of medicine as promotion of health, prevention of illness, restoration of the sick and rehabilitation. His statement that health was promoted by providing a decent standard of living, good labor conditions, education, physical culture, means of rest and recreation and required the co-ordinated efforts of statesmen, labor, industry, educators and physicians. It found reflections 40 years later in the Ottawa Charter for health promotion. Sigerist's observation that “the promotion of health obviously tends to prevent illness, yet effective prevention calls for special protective measures” highlighted the consideration given to the general causes in disease causation along with specific causes as also the role of health promotion in addressing these general causes. Around the same time, the twin causality of diseases was also acknowledged by J.A.Ryle, the first Professor of Social Medicine in Great Britain, who also drew attention to its applicability to non communicable diseases.( 7 )

Health education and health promotion are two terms which are sometimes used interchangeably. Health education is about providing health information and knowledge to individuals and communities and providing skills to enable individuals to adopt healthy behaviors voluntarily. It is a combination of learning experiences designed to help individuals and communities improve their health, by increasing their knowledge or influencing their attitudes, whereas health promotion takes a more comprehensive approach to promoting health by involving various players and focusing on multisectoral approaches. Health promotion has a much broader perspective and it is tuned to respond to developments which have a direct or indirect bearing on health such as inequities, changes in the patterns of consumption, environments, cultural beliefs, etc.( 3 )

The ‘New Perspective on the Health of Canadians’ Report known as the Lalonde report, published by the Government of Canada in 1974, challenged the conventional ‘biomedical concept’ of health, paving way for an international debate on the role of nonmedical determinants of health, including individual risk behavior. The report argued that cancers, cardiovascular diseases, respiratory illnesses and road traffic accidents were not preventable by the medical model and sought to replace the biomedical concept with ‘Health Field concept’ which consisted of four “health fields”-lifestyle, environment, health care organization, human biology as the determinants of health and disease. The Health Field concept spelt out five strategies for health promotion, regulatory mechanisms, research, efficient health care and goal setting and 23 possible courses of action. Lalonde report was criticized by skeptics as a ploy to stem in the governments rising health care costs by adopting health promotion policies and shifting responsibility of health to local governments and individuals. However, the report was lapped up internationally by countries such as USA, UK, Sweden, etc., who published similar reports. The landmark concept also set the tone for public health discourse and practice in the decades to come.( 7 – 10 ) Health promotion received a major impetus in 1978, when the Alma Ata declaration acknowledged that the promotion and protection of the health of the people was essential to sustained economic and social development and contributed to a better quality of life and to world peace.( 5 )

Conferences on Health Promotion

Growing expectations in public health around the world prompted WHO to partner with Canada to host an international conference on Health Promotion in 1986. It was held in Ottawa, and produced not only the “Ottawa Charter for Health Promotion” but also served as a prelude to subsequent international conferences on health promotion. The Ottawa Charter defined Health Promotion as the process of enabling people to increase control over and to improve their health. To reach a state of complete physical, mental and social well being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. The fundamental conditions and resources for health are: peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity. Health promotion thus is not just the responsibility of the health sector, but goes beyond healthy lifestyles to well being. The Charter called for advocacy for health actions for bringing about favorable political, economic, social, cultural, environmental, behavioral and biological factors for health, enabling people to take control of the factors influencing their health and mediation for multi sectoral action. The Charter defined Health Promotion action as one a) which builds up healthy public policy that combines diverse but complementary approaches including legislation, fiscal measures, taxation and organizational change to build policies which foster equity, b) create supportive environments, c) support community action through empowerment of communities - their ownership and control of their own endeavors and destinies, d) develop personal skills by providing information, education for health, and enhancing life skills and e) reorienting health services towards health promotion from just providing clinical and curative services.( 11 )

This benchmark conference led to a series of conferences on health promotion - Adelaide (1988), Sundsvall (1991), Jakarta (1997), Mexico-City (2000), Bangkok (2005) and Nairobi (2009). In Adelaide, the member states acknowledged that government sectors such as agriculture, trade, education, industry and communication had to consider health as an essential factor when formulating healthy public policy. The Sundsvall statement highlighted that poverty and deprivation affecting millions of people who were living in extremely degraded environment affected health. In Jakarta too poverty, low status of women, civil and domestic violence were listed as the major threats to health. The Mexico statement called upon the international community to address the social determinants of health to facilitate achievement of health-related millennium development goals. The Bangkok charter identified four commitments to make health promotion (a) central to the global development agenda; (b) a core responsibility for all governments (c) a key focus of communities and civil society; and (d) a requirement for good corporate practice.( 12 , 13 ) The last conference in October 2009 in Nairobi called for urgent need to strengthen leadership and workforce, mainstream health promotion, empower communities and individuals, enhance participatory processes and build and apply knowledge for health promotion.

The health promotion emblem [ Figure 2 ] adopted at the first international conference on health promotion in Ottawa and evolved at subsequent conferences symbolizes the approach to health promotion. The logo has a circle with three wings. It incorporates five key action areas in health promotion (build healthy public policy, create supportive environments for health, strengthen community action for health, develop personal skills and reorient health services) and three basic HP strategies (to enable, mediate and advocate).

Health promotion emblem

• The outer circle represents the goal of “Building Healthy Public Policies” and the need for policies to “hold things together”. This circle has three wings inside it which symbolise the need to address all five key action areas of health promotion identified in the Ottawa Charter in an integrated and complementary manner.
• The small circle stands for the three basic strategies for health promotion, “enabling, mediating, and advocacy”.
• The three wings represent and contain the words of the five key action areas for health promotion – reorient health services, create supportive environment, develop personal skills and strengthen community action.( 14 )

True to its recognition of health being more influenced by factors outside the health sector, health promotion calls for concerted action by multiple sectors in advocacy, financial investment, capacity building, legislations, research and building partnerships. The multisectoral stakeholder approach includes participation from different ministries, public and private sector institutions, civil society, and communities all under the aegis of the Ministry of Health.( 3 )

Approaches to Health Promotion

Health promotion efforts can be directed toward priority health conditions involving a large population and promoting multiple interventions. This issue-based approach will work best if complemented by settings-based designs. The settings-based designs can be implemented in schools, workplaces, markets, residential areas, etc to address priority health problems by taking into account the complex health determinants such as behaviors, cultural beliefs, practices, etc that operate in the places people live and work. Settings-based design also facilitates integration of health promotion actions into the social activities with consideration for existing local situations.( 3 )

The conceptual framework in Figure 3 below summarizes the approaches to health promotion. It looks at the need of the whole population. The population for any disease can be divided into four groups a) healthy population, b) population with risk factors, c) population with symptoms and d) population with disease or disorder. Each of these four population groups needs to be targeted with specific interventions to comprehensively address the need of the whole population. In brief, it encompassed primordial prevention for healthy population to curative and rehabilitative care of the population with disease. Primordial prevention aspires to establish and maintain conditions to minimize hazards to health. It consists of actions and measures that inhibit the emergence and establishment of environmental, economic, social and behavioral conditions, cultural patterns of living known to increase the risk of disease.( 15 )

Conceptual framework for health promotion

Examples of Health Promotion in Communicable and Non-communicable Diseases

Health promotion measures are often targeted at a number of priority disease – both communicable and noncommunicable. The Millennium Development Goals (MDGs) had identified certain key health issues, the improvement of which was recognized as critical to development. These issues include maternal and child health, malaria, tuberculosis and HIV and other determinants of health. Although not acknowledged at the Millennium summit and not reflected in the MDGs, the last two decades saw the emergence of NCD as the major contributor to global disease burden and mortality. NCDs are largely preventable by effective and feasible public health interventions that tackle major modifiable risk factors - tobacco use, improper diet, physical inactivity, and harmful use of alcohol. Eighty percent of heart diseases and stroke, 80% of diabetes and 40% of cancers can be prevented by eliminating common risk factors, namely poor diet, physical inactivity and smoking.( 16 ) Against this background health promotion as the “the science and art of helping people change their lifestyle to move toward a state of optimal health” is a key intervention in the control of NCDs. The following paragraphs showcase the application of an issue based approach of health promotion, using communicable and NCDs as examples capturing the components of individual and community empowerment, health system strengthening and partnership development.

Communicable Diseases

These diseases can be adequately addressed through health promotion approach. Here is one example:

Improving use of ITNs to prevent malaria: Insecticide-treated bed-nets (ITNs) are recommended in malaria endemic areas as a key intervention at the individual level in preventing malaria by preventing contact between mosquitoes and humans. (a) The individual level health promotion action would include providing access to ITNs and encouraging their regular and proper use every night from dusk to dawn. Available evidence points to the fact that this can be best achieved by social marketing campaigns to promote demand of ITNs. The messages should be tailored to cultural beliefs, for example the belief in some communities that mosquitoes have no role in the etiology of malaria. Distribution of ITNs to the community should ideally be followed by ‘hang up’ campaigns by trained health care workers educating the community on how to use the nets and helping them hang the nets, especially for the most vulnerable groups. (b) The community empowerment efforts, a collaborative initiative with the community to understand the cultural beliefs and behaviours and educating them about the disease would produce desirable results. There are documented examples of how women in a community empowerment program in Thailand developed family malaria protection plans, provided malaria education to community members, mosquito-control measures in a campaign, scaled-up use of insecticide-impregnated bed nets, instituted malaria control among migrant labourers, as well as activities to raise income for their families. Another program in Papua New Guinea empowered community members to take responsibility for the procurement, distribution and effective use of bed nets in the village, which led to a significant decrease in the incidence of malaria-related mortality and morbidity. (c) Strengthen health systems, integration of malaria vector control and personal protection into the health system through innovative linkages to ongoing health programs and campaigns is likely to lead to strong synergies, economies, and more rapid health system strengthening compared to new vertical programmes.. Successful examples of this include piggybacking the distribution of ITNs through antenatal care or immunization campaigns for measles and polio. (d) Partnerships are key in malaria control because of the involvement of multiple sectors. Action outside the health sector to remove barriers to the uptake of malaria prevention strategies has included lobbying for reduction or waiver of taxes and tariffs on mosquito nets, netting materials and insecticides and stimulating local ITN industries. Intersectoral collaboration has played an integral role in vector control measures for malaria prevention, including environmental modification, larval control, etc.( 17 )

Noncommunicable Diseases

In NCDs, two path-breaking studies need special mention. These studies are the Framingham Heart Study (started in 1951) and study on smoking among British doctor (started in 1948) have helped us in understanding how lifestyle affects various NCDs. The study in British doctors showed that prolonged cigarette smoking from early adult life tripled age-specific mortality. The excess mortality associated with smoking mainly involved vascular, neoplastic and respiratory diseases caused by smoking. The Framingham Heart Study has led to the identification of major CVD risk factors such and blood pressure, blood triglycerides and cholesterol level, age, gender and psychosocial issues (Framingham Heart Study).( 18 )

Cardiovascular Diseases

In the early 1970s the mortality rate from coronary heart disease was the highest in the world among men of Finland. The dietary practices of the Finnish population centered around dairy products and their food was rich in saturated fats, salt and low in unsaturated fats, fruits and vegetables. The North Karelia project, a major community-based intervention was launched in North Karelia, a fairly rural and economically poor province. This project developed comprehensive community based strategies to change the dietary habits of the population, with the main goal to reduce the high cholesterol levels in the population. The strategy focused on reduction intake of high saturated fat as well as the salt intake and to increase the consumption of fruits and vegetables. At the individual and community level, health information and nutritional counseling were made available, skills were developed, social and environmental support was provided all the while ensuring community participation. The health system was closely involved with the project. The project also developed strong partnerships with schools, health related and other nongovernmental organizations, supermarkets and food industry, community-based organizations and media. Collaborations were done with the food industry to reduce the fat and salt content of common food items such as dairy food, processed meat and bakery items. Dairy farmers were encouraged to switch to berry farming through the launching of a Berry project. The North Karelia project was extended to the entire country with the health care services also responsible along with schools and nongovernmental agencies in implementing nutrition and health education. Nation-wide nutrition education and collaboration with food industry were backed by legislative actions and were rewarded with remarkable results. Surveys showed a transformation in dietary habits with a marked reduction intake in saturated fats and salt and declared ischemic heart disease mortality declining by 73% in North Karelia and by 65% in Finland from 1971 to 1995.( 19 )

Diabetes Mellitus

Diabetes mellitus is one of the NCDs which has led to high rates of morbidity and mortality worldwide. Health promotion is being increasingly recognized as a viable, cost-effective strategy to prevent diabetes. The interventions at the individual and community level includes lifestyle modification programs for weight control and increasing physical activity with community participation using culturally appropriate strategies. The Kahnawake School's Diabetes Prevention Project (KSDPP) in Canada provides an example of a project that involved the local Mohawk community, researchers and local health service providers, in response to requests from the community to develop a diabetes prevention program for young children. The long-term goal of KSDPP was to decrease the incidence of type 2 diabetes, through the short-term objectives of increasing physical activity and healthy eating. Such preventive interventions have to be backed by strengthening of the health system which combines identification of high risk groups with risk factor surveillance and availability of trained primary health care providers for risk assessment and diabetes management. Online training courses offer an innovative approach to enhance health system capacity for diabetes health promotion, such as a course targeted at workers in remote indigenous communities in the Arctic to foster learning related to the Nunavut Food Guide, traditional food and nutrition, and diabetes prevention. Partnership and network development is key to the achievement of these measures. As part of the city-wide ‘Let's Beat Diabetes initiative’ in South Auckland, New Zealand the district health board with support from local government provided safe environments for physical activity by upgrading parks and worked with the food industry to provide healthier food options at retail outlets in order to reduce consumption of sweetened soft drinks and energy dense foods. Sugar-free soft drinks were made available as default options to customers, unless specifically requested otherwise. Intersectoral action on risk factors for diabetes also acts on the determinants of the other major risk factors for the NCD burden, such as heart disease, cancer and respiratory disease, hence health promotion activities aimed at reducing risk of diabetes mellitus have added advantages.( 17 )

Settings Based Approach to Health Promotion

The concept of ‘healthy settings’ which maximizes disease prevention through a whole system approach had emerged from WHO's Health for All strategy and Ottawa Charter. The call for supportive environments was followed up by the Sundwal statement of 1992 and the Jakarta declaration of 1997. The settings approach builds on the principles of community participation, partnership, empowerment and equity and replaces an over reliance on individualistic methods with a more holistic and multidisciplinary approach to integrate action across risk factors. The ‘Healthy Cities’ programme launched by WHO in 1986 was soon followed up by similar initiatives in smaller settings such as schools, villages, hospitals, etc.( 20 )

Health Promoting Schools

Health promoting schools build health into all aspects of life in school and community based on the consideration that health is essential for learning and development. To further this concept, WHO and other UN agencies developed an initiative, ‘Focusing Resources on Effective School Health (FRESH), emphasizing on the benefit to both health and education if all schools were to implement school health policies, a healthy school environment, with the provision of safe water and sanitation an essential first step, skills-based health education and school-based health and nutrition services.( 21 )

Healthy Work Places

Currently, globally an estimated two million people die each year as a result of occupational accidents and work-related illnesses or injuries and 268 million nonfatal workplace accidents result in an average of three lost workdays per casualty, as well as 160 million new cases of work-related illness each year.( 22 ) Healthy work places envision building a healthy workforce as well as providing them with healthy working conditions. Healthy working environments translate to better health outcomes for the employees and better business outcomes for the organizations.( 23 )

Health Promotion in India

Health promotion is strongly built into the concept of all the national health programs with implementation envisaged through the primary health care system based on the principles on equitable distribution, community participation, intersectoral coordination and appropriate technology. Nevertheless, it has received lower priority compared to clinical care. The government, through the component of IEC has always strived to address the issue of lack of information, which is a major barrier to increasing accessibility of health care services.( 24 ) The National Rural Health Mission (NRHM) called for a synergistic approach by relating health to determinants of good health such as segments of nutrition, sanitation, hygiene and safe drinking water and by revitalizing local traditions and mainstreaming the Ayurvedic, Unani, Siddha and Homeopathic systems of medicine to facilitate health care.( 25 ) NRHM offers an excellent opportunity to target and reach every beneficiary with appropriate interventions through microplanning into district planning process.( 26 )

Health promotion component needs to be strengthened with simple, cost-effective, innovative, culturally and geographically appropriate models, combining the issue-based and settings-based designs and ensuring community participation. Replicability of successful health promotion initiatives and best practices from across the world and within the country needs to be assessed. Efforts have already been initiated to build up healthy settings such as schools, hospitals, work places, etc.( 20 , 22 , 27 ) For effective implementation of health promotion we need to engage sectors beyond health and adopt an approach of health in all policies rather than just the health policy.

Conclusions

Today, there is a global acceptance that health and social well being are determined by a lot of factors which are outside the health system which include inequities due to socioeconomic political factors, new patterns of consumption associated with food and communication, demographic changes that affect working conditions, learning environments, family patterns, the culture and social fabric of societies; sociopolitical and economic changes, including commercialization and trade and global environmental change. To counter the challenges due to the changing scenarios such as demographic and epidemiological transition, urbanization, climate change, food insecurity, financial crisis, etc. health promotion has emerged as an important tool; nevertheless the need for newer, innovative approaches cannot be understated. A multisectoral, adequately funded, evidence-based health promotion program with community participation, targeting the complex socioeconomic and cultural changes at family and community levels is the need of the hour to positively modify the complex socioeconomic determinants of health.

Source of Support: Nil

Conflict of Interest: None declared.

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Promoting health and preventing ill health Essay Sample

Promoting health: schizophrenia.

This essay is based on the prevention and promotion of schizophrenia. The paper will begin by describing the background of schizophrenia. It will also explain the rationale for selecting schizophrenia as a health condition for this essay. Next, the paper will provide a critical discussion on the epidemiology of schizophrenia, including the risk factors, vulnerable population, its presentation, and prevalence in the UK. Additionally, the essay will explain the assessment of schizophrenia and the applicable assessment tool. The next section of the paper will describe three health promotion goals that the paper intends to realise by completing this work. Furthermore, it will provide a critical discussion on the interventions for health promotion goals, including roles of individual and his/her social network, multi and interdisciplinary teams, organisations, and departments, among others. Lastly, the essay will provide a critical discussion on evaluating health promotion care planning, including its effectiveness, alternatives, justification, and recommendations. The conclusion will contain a summary of key elements discussed throughout the essay.

Background of Schizophrenia

Swiss Psychiatrist Paul Eugen Blueuler first coined the term schizophrenia in 1910. In Greek, the words schizo mean 'spilt' and phren means 'mind.' schizophrenia was initially intended to mean 'loosing of mind and feelings' since it was characterised by fragmented thinking and mental confusion. It was also referred to as 'split personality (Perkovic et al., 2017). However, National Collaborating Centre for Mental Health (Great Britain) (2013) indicates that schizophrenia is not a split or multiple personality but involves psychosis where one cannot differentiate what is imagined and what is real. The world may appear to them as a jumble of confusing sounds, thoughts, and images. The individual with schizophrenia struggle in the society and hardly do well in school at work, and in relationships. Often, they feel withdrawn and frightened.

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Emil Kraepelin first defined schizophrenia as dementia praecox, a progressive mental health disorder of unknown aetiology. He observed the early onset of the condition to begin in adolescence, leading to a less or more irreversible deterioration in cognitive and functional capacity (Kendler 2020). According to National Collaborating Centre for Mental Health (Great Britain) (2013), schizophrenia is a chronic, severe mental disorder characterised by distorted thinking, emotions, perceptions, language, behaviour, and sense of self. According to Perkovic et al. (2017), the symptoms of schizophrenia include hallucination, delusion, lack of motivation, disorganised speech, and trouble with thinking. Early interventions diminished reoccurrences and contribute to improved quality of life. However, Perkovic et al. (2017) assert that schizophrenia does not any known cure, but there are antipsychotic medications that help elevate the symptoms and improve long-term outcomes.

Knowledge and early intervention of schizophrenia are crucial to individual quality of life, health, and wellbeing. Catalano et al. (2021) noted that schizophrenia could be disabling and change the course of one's life. The early onset-of schizophrenia begins in young adults and threatens an individual's independence and quality of life at a crucial time (Kimotho 2018).  Timely access to necessary support and treatment enabled people with schizophrenia to lead a healthy life, work, have families, and pursue their life goals, thus, positively contributing to society. Moreover, for decades, societies have stigmatised and stereotyped people with mental health conditions such as schizophrenia as violent and split or multiple personalities. Moreover, there are also myths that individuals with schizophrenia belong to the mental hospital and cannot recover.  Katschnig (2018) also argued that society treats individuals with schizophrenia as lesser humans, making them feel isolated and deprived of social life. According to Kimotho (2018), this contributes to further stress and depression, which affect even those who are already on medication. Therefore, it is essential to promote health to enhance early interventions and adherence to treatment and change the societal perspective regarding schizophrenia.

Epidemiology of Schizophrenia

Schizophrenia is a major psychiatric disorder that changes one's perception, thoughts, and behaviour. The positive symptoms include delusion, hallucination, and negative thoughts comprise emotional apathy, poverty of speech, social withdrawal, self-neglect, and lack of drive (Halvorsrud et al., 2019). Schizophrenia is unequally distributed in society. According to Cadge, Connor, and Greenfield (2019), schizophrenia tends to more prevalent in lower- socio-economic groups. Halvorsrud et al. (2019) also state that men are 1.4 times likely to develop schizophrenia compared to women. Wang et al. (2020) indicated that the incidence of schizophrenia is about 16 per 1000 people. The condition affects 0.7% of the UK population (Cadge, Connor, and Greenfield 2019).  According to the Office for Statistics, Schizophrenia affects about 9.65 of children between 5 and 16 years and accounts for about 25% of the mental health disorders among adolescents between ages 10 to 18 years (Halvorsrud et al., 2019).

Janoutová et al. (2016) indicated that one quarter has wholly recovered in long-term follow-up on people who have schizophrenia. Most conditions have improved while deteriorations are only 10% throughout their lifetime. Halvorsrud et al. (2019) argued that schizophrenia has a worse prognosis with early onset in childhood or adolescence than onset in adult life. Wang et al. (2020) also indicate that about one-fifth of individuals with schizophrenia experienced positive outcomes with only mild impairment. Halvorsrud et al. (2019) indicate that one-third of individuals with Schizophrenia present severe impairment that requires psychiatric and intensive social support. According to Cadge, Connor, and Greenfield (2019), individuals with schizophrenia have a 5 to 10% chance of dying by their own hands within 10 years after being diagnosed with schizophrenia which is around 3times higher compared to the general population.

The risk factors for schizophrenia include genetics; there is a greater likelihood of schizophrenia being passed to children from parents. Secondly, environmental factors such as exposure to toxins like marijuana, viral infections, or highly stressful situation can trigger Schizophrenia (Wang et al. 2020). Schizophrenia can also result from brain abnormality and changes in brain chemistry and circuits.

Early diagnosis of schizophrenia is essential in reducing the challenges such as social, physical, and economic impacts and its debilitating effects. Holistic and systematic assessment is crucial to both the service user and physician (Macfadden et al., 2011). The presence and severity of schizophrenia can be screened using Clinical Global Impression-Severity (CGI-SCH) scale. CGI-SCH is effective in assessing positive, negative, depressive, and cognitive symptoms of schizophrenia. Grover et al. (2017) also indicates that CGI-SCH is a reliable and valid questionnaire used to evaluate the severity and treatment response in schizophrenia. Additionally, the service user's functionality can be assessed using the Personal and Social Performance (PSP) scale, Strauss-Carpenter Levels of Functioning (LOF), and Global Assessment of Functioning (GAF) (Psychosis, NICE 2014). These assessment tools are used to rate the service users functioning over the past months in four areas, including personal and social relationships, aggressive and disturbing behaviour, self-care, and engagement in socially useful activities.

The physicians assign scores from 1 (lack of autonomy in basic functioning) to 7 (excellent functioning) in all four areas. The service user's health status is also assessed using Medical Outcomes Survey Short Form -36 (SF-36). The survey has 36 items and screens the service user's health status over the past four weeks in eight different areas, including physical health. The survey evaluates body pain, general health, physical functioning, and role-physical (Grover et al., 2017). The mental health assessment comprises role emotional, mental health, social functioning, and vitality. The assessment evaluates for adverse events and serious adverse events associated with schizophrenia. According to Psychosis, NICE (2014), the Diagnostic and Statistical Manual (DSMIV-TR) is used to evaluate the presence of schizophrenia based on the symptoms presented and to rule out the presence of schizoaffective and mood disorder.

Health Promotion Goal

The increased medical morbidity and mortality are associated with schizophrenia and related mental health disorders. The additional deaths are historically attributed to suicide and accidents (Stilo and Murray 2019). However, these only accounts for a small fraction of deaths as most deaths related to schizophrenia emerge from physical illness. The World Health Organisation definition of healthy life comprises mental, physical, and emotional health. The goals of health promotion for schizophrenia will thus reflect the physical, social, and emotional health of service users.

Goal 1: To create public awareness on factors influencing an individual's wellbeing to minimise mental health by 30% by 1 st December 2022. While there are many misconceptions about mental health, specifically schizophrenia, society has no adequate information regarding factors, such as environmental factors, such as drug and substance abuse and depression, contributing to Schizophrenia (Stilo and Murray 2019). Moreover, the goal aims to create a supportive society that tolerates, accommodates, and supports individuals with mental health issues to support their recovery.

Goal 2: To conduct education and training programs to educate people with schizophrenia about their conditions to stimulate self-acceptance and positive coping mechanisms to promote medication adherence and minimise relapse by 40% by 1 st December 2022.  Leonhardt, Hamm, and Lysaker (2020) indicate that most people with schizophrenia hardly accept their condition and are forced to take their medication under supervision. Lack of self-acceptance and limited information regarding one's mental health status reduces their compliance to medication and commitment to the recovery process leading to relapse and further deterioration.  

Goal 3: To train people with psychosis on nutrition, physical activity, and healthy living style to reduce obesity-associated antipsychotic medications by 60% by 1 st December 2022. Antipsychotic drugs are known to have a side-effect on weight gain (Townsend 2018). Weight gain can contribute to depression, lack of self-esteem, and social withdrawal, thereby contributing to further deterioration. Thus, the goal is to ensure that people diagnosed with schizophrenia and are under antipsychotic medications adopt healthy living habits.

Interventions

The physical and social health disparity of individuals with schizophrenia and severe mental illness is increasingly concerning. Besides the unwanted side-effects of antipsychotic medications, the increased morbidity is attributed to adverse lifestyle factors such as physical inactivity, poor diet, and drug and substance abuse (Tranter and Robertson 2021). Additionally, the social determinates of mental health, such as families, individuals, community, and the entire population, also increase the risk of mental health condition and substance user disorder, thereby worsening the existing mental illness or substance abuse (Compton and Shim 2020). Therefore, the multidisciplinary approach can be adopted to implement evidence-based interventions that aim to minimise mental health conditions, promote recovery, and improve quality of life and health outcomes.

The community mental health nurses, social workers, and psychologists will work alongside public health organisations to employ a universal approach in educating the community members about schizophrenia. The initiative will promote healthy lifestyles, clarify misconceptions and myths about schizophrenia, prevent the onset, and eliminate or reduce causal risk factors such as substance abuse (Compton and Shim 2020). The intervention will also aim to provide society with adequate information regarding the need for early screening and check-ups to identify the early onset of schizophrenia and make a timely intervention. However, Tanaka et al. (2018) noted that mental health's societal attitudes and stereotypes prevent people from accepting their mental health conditions and challenging them not to seek mental health screening.  Catalano et al. (2021) also reiterate that societal beliefs and attitudes toward mental illness impede the recovery process of individuals with schizophrenia due to social isolation, discrimination, and prejudice. Thus, the educational and information campaign will ensure that community members understand accurate and precise information about mental health conditions and change their attitudes and behaviour towards people with mental health conditions.  

Additionally, the psychologist, mental health nurses, psychiatrist, GP, and the government will selectively work with individuals diagnosed with schizophrenia to promote their adherence to medication and self-acceptance (Compton and Shim 2020). The team will employ diverse strategies, including restrictions, enablement, environmental restructuring, persuasion, and education, to promote the behaviour change. Education will increase the service users' knowledge and understanding of their condition and encourage self-care.  The government will equally play a role in passing rules, legislations, policies, and guidelines to reduce opportunities for people with schizophrenia to access drugs and substances and promote inclusion. The government can also encourage people with schizophrenia by passing regulations and legislation that eliminate the criminal justice system, employment, educational, and financial inequalities (Carney, Bradshaw, and Yung 2016). Moreover, environmental restructuring will be employed to change people's social and physical context with schizophrenia. These will include providing diet, private gym, and behavioural support classes to help service users participate in interventions together with the trainer. According to Valiente et al. (2021), lack of self-acceptance limits medication adherence and management. These interventions will eliminate barriers to early screening and early interventions to prevent the prevalence of schizophrenia.

Furthermore, obesity, as a side effect of antipsychotic drugs in people with schizophrenia, increases physical disability, mortality, and morbidity. For instance, the health effects of obesity include high blood pressure, diabetes, heart disease and stroke, breathing difficulties, and cancer. Moreover, the individual with increased body weight due to antipsychotic medication is likely to get depressed due to their new appearance (Luo et al. 2020). This can further contribute to depression, stress, and suicidal behaviour. The intervention will thus focus on ways to prevent relapse and adopt healthy lifestyles that prevent obesity. This intervention will require a nutritionist to personalise a healthy diet to service users. The physician will also actively work with the service user to engage in physical activities. Other multidisciplinary teams in this intervention will include service user's family members and carers to provide them with social support. The community mental health nurse also assesses medication adherence, and the social workers will assess service users' living conditions, self-care, and living activities.

Evaluation of health promotion care planning

Mental health influenced an individual's quality of life and can be maintained by finding a community for social support. Shereda et al. (2019) asserted that community is about feeling connected to and accepted by others. Cochrane, Moran, and Newton (2021) argue that loneliness and isolation deteriorate people with mental health conditions. As such, an inclusive, accommodating, and supportive community is critical for people with schizophrenia to thrive. Also, Shereda et al. (2019) stipulated the importance of early screening to improve mental health conditions and recovery management. However, the traditional beliefs and misconceptions about mental illness have persistently hindered people from undertaking early mental health screening to escalate recovery-focused interventions. Elraz (2018) further suggested that mental illness misconceptions have promoted isolation and discrimination against people with mental health conditions. El-Nady et al. (2018) also indicated that community-level initiatives effectively reduce discrimination and stigma, promote mental health awareness, prevent mental disorders, and support social inclusion and recovery. Thus, public education is a critical strategy intervention that helps change society's mind towards mental illness and develop a more inclusive and supportive culture towards people with schizophrenia.

Additionally, the interventions geared towards people with schizophrenia are critical in improving their understanding of their mental condition, accept-self, and adhere to medications (Nguyen et al. 2020). In addition, government interventions through legislative and policy initiatives will improve individual's access to employment and educational opportunities, thus reducing the concern that if one is screened and found to have a mental health condition (Gray, Davies, and Snowden 2020), they are still confident of completing their education, securing jobs, and being accommodated in the society. Cochrane, Moran, and Newton (2021) confirmed that psycho-education and training effectively help the service user deal with the social stigma associated with schizophrenia and cope with emotional distress. Gurusamy et al. (2018) also reiterated that psycho-education coupled with family interventions improves mental health outcomes and reduces relapse rates. Elraz (2018) also noted that antipsychotic drugs are associated with weight gain, leading to serious psychological and physical health effects. Consequently, the Nursing and Midwifery Council (2018) contend that service users with schizophrenia must be informed of the negative and positive outcomes of these medications and other available evidence-based alternative options so that they can make informed treatment options. Shereda et al. (2019) also argued that individuals with schizophrenia under antipsychotic medications must be trained to engage in healthy eating habits, physical activity and adopt healthy lifestyles.

Alternative Health Promotion Initiatives for Schizophrenia: The alternative options in promoting health for schizophrenia include coercion and modelling. The coercion could be used to ensure that people with schizophrenia are prohibited from undertaking unhealthy habits such as substance abuse, physical inactivity, unhealthy eating and are forced to take their prescriptions to prevent relapse. Secondly, modelling can inspire and motivate people with schizophrenia to imitate healthy lifestyles and adhere to their drugs.

Justification: Some people with schizophrenia hardly accept their mental health conditions, hence reluctant to take their prescriptions without supervision. Moreover, Baldacchino and Sharma (2021) noted that people with schizophrenia are more likely to involve in drug and substance abuse which exacerbates their conditions. Besides, Zhou and Li (2020) indicated that collaborative modelling effectively helps individuals with schizophrenia to shift their negative energy and attitude to productive lifestyles and adhere to their care plan. Collaborative modelling fosters self-management (Mezey et al., 2021). Therefore, coercion and modelling are equally effective approaches in helping persons with schizophrenia to adhere to their medications and adopt necessary lifestyles to prevent adverse effects of antipsychotic drugs.

Recommendation : Brown et al. (2019) indicated that while mental health conditions affect the community regardless of class, people in low-income communities face serious mental health inequities. Hence, the mental health promotional programs and government interventions should focus on low-income communities to increase the community knowledge of mental health conditions and stimulate healthy mental health practices.

Health promotion is critical in empowering individuals to control their health and recovery process and health outcomes. The traditional beliefs, myths, stigma, and stereotypes of psychosis continue to lower the confidence and self-esteem of people diagnosed with mental health conditions. Consequently, people are reluctant to screen for their mental health and access early interventions to fear being stigmatised and discriminated against. The health promotion program for schizophrenia thus targets the community, families, and individuals and encompasses multidisciplinary teams' efforts to change society's attitude and behaviour toward mental health conditions. The initiatives, including public education and campaigns, psycho-education and training, persuasion, and restriction of service users, were adopted to enhance community and individual response to schizophrenia. These programs, alongside government intervention, are critical in helping individuals accept their mental health conditions, adhere to their medications, and adopt healthy eating and healthy lifestyles. 

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Cadge, C., Connor, C., and Greenfield, S., 2019. University students' understanding and perceptions of Schizophrenia in the UK: a qualitative study.  BMJ Open ,  9 (4), p.e025813.

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Home — Essay Samples — Nursing & Health — Obesity — Obesity – A Big Public Health Issue In England

Obesity – a Big Public Health Issue in England

• Categories: Obesity

About this sample

Words: 1466 |

Published: Feb 8, 2022

Words: 1466 | Pages: 3 | 8 min read

Table of contents

Introduction, epidemiology, public health interventions, health promotion model.

• World Health Organization 2019 – Health Topics :Obesity definition. Available at https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight Accessed 03-12-2019
• National Health Service 2019 -Causes of obesity. Available at https://www.nhs.uk/conditions/obesity/ Accessed 03-12-2019
• Merriam Webster since 1828. 2019. Available at https://www.merriam-webster.com/ Accessed 03-12-2019
• National Health System Digital 2019. Available at https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-obesity-physical-activity-and-diet/statistics-on-obesity-physical-activity-and-diet-england-2019. Accessed 03-12-2019
• National Health System Digital 2019. Publication -Statistics on Obesity, Physical Activity and Diet, England. Available at https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-obesity-physical-activity-and-diet/statistics-on-obesity-physical-activity-and-diet-england-2019
• Queens University Belfast 2009 – Health Promotion https://www.qub.ac.uk/elearning/public/HealthyEating/HealthPromotion/ Accessed 03-12-2019
• House of Commons Library 2019 : Briefing paper by Carl Baker Obesity statistics available at https://researchbriefings.files.parliament.uk/documents/SN03336/SN03336.pdf Accessed 07-01-2020
• Public Health England 2019 : Adult obesity applying all our health Available at https://www.gov.uk/government/publications/adult-obesity-applying-all-our-health/adult-obesity-applying-all-our-health Accessed 03.12.2019
• Public Health England: Public Health Profiles. Available at https://fingertips.phe.org.uk/search/overweight#page/4/gid/1/pat/202/par/E09000017/ati/201/are/E09000017/iid/93088/age/168/sex/4 Accessed 07-01-2020
• Public Health England ( protecting and Improving the nations health) Sugar Reduction Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/604336/Sugar_reduction_achieving_the_20_.pdf Accessed 07-01-2020
• The Queens Nursing Institute 2020 (QNI) Available at https://www.qni.org.uk/nursing-in-the-community/work-of-community-nurses/general-practice-nurse/ Accessed 10-01-2020
• National Health System England. Health Education England : Health Careers. Available at https://www.healthcareers.nhs.uk/explore-roles/nursing/roles-nursing/general-practice-nurse Accessed 10-01-2020
• Nursing and Midwifery Council: Standard of Proficiency for registered nurses. Available at https://www.nmc.org.uk/standards/standards-for-nurses/standards-of-proficiency-for-registered-nurses/ Accessed 10-01-2020 

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