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บทบาทของคณะแพทยศาสตร์�ในการ์จั�ดการ์ศ�กษาด�าน
การ์สร์�างเสร์�มส�ขภาพอาน�ภาพ เลขะก�ล
คณะแพทยศาสตร์� มหาวิ�ทยาล�ยสงขลา
นคร์�นทร์�
Scope of PresentationScope of Presentation
• Concept of health promotion
• Medical school and HP
Health Promotion in Medical Curriculum, PSU
Medical EducationMedical Education
Health Promotion in Medical Curriculum, PSU
Health Care System
Medical Service Medical Education
Concept of Health PromotionConcept of Health Promotion
Health Promotion in Medical Curriculum, PSU
Health Promotion in Medical Curriculum, PSU
สร้�างนำ�าซ่อมนำโยบายสร้�างเสร้�มส�ขภาพ
ใคร้ สร้�าง……ใคร้ ซ่อม……สร้�าง อยางไร้……
Health Promotion in Medical Curriculum, PSU
นำโยบายสร้�างเสร้�มส�ขภาพ
การ้สงเสร้�มส�ขภาพvs
การ้สร้�างเสร้�มส�ขภาพ
Health Promotion in Medical Curriculum, PSU
Health
Health CareOrganization
Lifestyle
Human Biology
Environment
Lalonde, 1974
PovertyFood poverty, Fuel poverty
Poor housing, Poor transportSocial isolation, Relative powerlessnessPoor access to recreation/social facilities
Physical Health EffectsLow birth weightsInfant deathsPoor growth in childrenRespiratory diseasesHeart diseaseAccidents
PsychologicalHealth EffectsStressAnxietyDepressionLow self-esteem
Behavioral changes
SmokingDrug abuseLow exercise levelsPoor diets
How How PP overty overty AA ffects ffects HHealthealth
Health Promotion in Medical Curriculum, PSU
1992(Blackburn, )
Maslow’s NeedsMaslow’s Needs
Physiological Needs
Safety Needs
Needs for Love & Care
Esteem Needs
Self Actualization
Health Promotion (WHO)Health Promotion (WHO)
• A process of enabling people to increase control over and improve their health• To reach a state of complete physical, mental, social and spiritual 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 Promotion in Medical Curriculum, PSU
From disease prevention to health promotion
Health Promotion in Medical Curriculum, PSU
Levels of Disease Levels of Disease PreventionPrevention
Health Promotion in Medical Curriculum, PSU
Behavioralrisk factors• Tobacco• Alcohol• Physical inactivity• Diet
Physiologicalrisk factors• BMI (Obesity)• Blood pressure• Blood glucose• Cholesterol
Diseaseoutcomes• Heart disease• Stroke• Diabetes• Cancer• Accidents• COPD• Chronic diseases
Health Promotion (WHO)Health Promotion (WHO)
• A comprehensive social and political process • It not only embraces actions directed at strengthening the skills and capabilities of individuals, but also action directed towards changing social, environment and economic conditions so as to alleviate their impact on public and individual health
Health Promotion in Medical Curriculum, PSU
• Health is, therefore, seen as a resource of everyday life, not objective of living
• “…the health of populations will not be improved without the participation of
all groups with an interest in and an influence on health care..”
Health Promotion in Medical Curriculum, PSU
Health PromotionHealth Promotion
Three Basic Strategies Three Basic Strategies forfor
Health PromotionHealth Promotion• Advocacy Political, economic, social, cultural, environment,
behavioural and biological factors can all favour health or be harmful to it.
• Enabling To support people in communities to achieve
their full health potential and to reduce health inequalities
• Mediating To coordinate and collaborate all groups
concerned
Five Priority Actions for Health Promotion (The Ottawa Charter,
1986)
Five Priority Actions for Health Promotion (The Ottawa Charter,
1986)• Building a healthy public policy• Creating supportive environments• Developing personal skills• Strengthening community action• Reorienting health service (from tertiary to primary)
Health Promotion in Medical Curriculum, PSU
Five Priority Actions for 21st Century
Health Promotion (Jakarta Declaration,
1997)
Five Priority Actions for 21st Century
Health Promotion (Jakarta Declaration,
1997)• Promote social responsibility for health• Increase investments for health development• Expand partnerships for health promotion• Increase community capacity and empower the individual• Secure an infrastructure for health promotion
Health Promotion in Medical Curriculum, PSU
Key Issues in Health Promotion
Key Issues in Health Promotion
• Equity Being fair and just, not equality• Effectiveness and evidence-based practice• Collaborative working
Health Promotion in Medical Curriculum, PSU
Effectiveness and Effectiveness and- Evidence based Practice- Evidence based Practice
• Medical model RCT, challenged extensively in the literature• Educational model Ensure clients and patients have access to information• Behavioural model Promote behavioral changes linked to health lifestyles• Social model Modify people’s environment• Empowerment model Empowerment of individuals and communities
Health Promotion in Medical Curriculum, PSU
Collaborative Working Collaborative Working
• Identify the need for shared objectives• Innovative work• Commitment of time• Resources and energy• Regular review procedures• Importance of key players• Impact of different professional and organization culture• Impact of funding issues
Health Promotion in Medical Curriculum, PSU
Focus of Intervention Individual Collective
Mode of InterventionAuthoritative
Negotiated
Beattie’s Model of Beattie’s Model of Health Promotion Health Promotion
Health Promotion in Medical Curriculum, PSU
Focuses/Levels of Focuses/Levels of Health PromotionHealth Promotion
• An individual
• Organization level Healthy cities, villages,
islandsHealthy promoting schools,
hospitals, market placesHealthy workplaces
• Community level
Medical School and HPMedical School and HP
Health Promotion in Medical Curriculum, PSU
Medical Schools and Medical Schools and HPHP
• Health Promoting Hospital
• Health Promotion in Higher Education
• Health Promotion in Medical Curriculum
• Medical Schools and Communities
Medical Schools and Medical Schools and HPHP
• Health Promoting Hospital
• Health Promotion in Higher Education
• Health Promotion in Medical Curriculum
• Medical Schools and Communities
Health Promotion in Health Promotion in HospitalsHospitals
• Management Policy• Patient Assessment• Patient Information and Intervention• Promoting a Healthy Workplace• Continuity and Cooperation
Medical Schools and Medical Schools and HPHP
• Health Promoting Hospital
• Health Promotion in Higher Education
• Health Promotion in Medical Curriculum
• Medical Schools and Communities
Health Promotion in Health Promotion in Higher Education Higher Education
(ACHA)(ACHA)• Integration with the learning mission
of higher education• Collaborative practice• Cultural competence• Theory-based practice• Evidence-based practice• Continuing professional development
and service
Medical Schools and Medical Schools and HPHP
• Health Promoting Hospital
• Health Promotion in Higher Education
• Health Promotion in Medical Curriculum
• Medical Schools and Communities
Planning a Curriculum Planning a Curriculum
• Identifying the need• Establishing the learning outcomes• Analysing possible constraints (SWOT analysis) • Agreeing the content• Organising the content including the sequence• Deciding the educational strategy
Health Promotion in Medical Curriculum, PSU
Planning a Curriculum Planning a Curriculum
• Deciding the teaching methods• Preparing the assessment• Communication about the curriculum• Promoting an appropriate educational environment• Managing the curriculum
Health Promotion in Medical Curriculum, PSU
What to TeachWhat to Teach
• Cognitive (Knowledge)• Skills• Affective
Health Promotion in Medical Curriculum, PSU
Application of HP Components in Teaching
Application of HP Components in Teaching
• Building a healthy public policy• Creating supportive environments Building environment in favor of staff and patient’s health• Developing personal skills Learning and skills development in communicating with patients and relatives
Health Promotion in Medical Curriculum, PSU
Application of HP Components in Teaching
Application of HP Components in Teaching
• Strengthening community action Empower community of decide, of their own, the right choices of their health• Reorienting health service (from tertiary to primary) Holistic approach for promotive, preventive and curative
Health Promotion in Medical Curriculum, PSU
Examples of Core ContentExamples of Core Content• Health behavior model• Determinants of health• Concept of healthy lifestyle and health promotion• Social aspect of health and diseases • Health promotion model and level : Individual, group/organization, community• Self-development and technique• Communication skills : counseling, group dynamics, social marketing
Health Promotion in Medical Curriculum, PSU
Examples of Core ContentExamples of Core Content• Health promotion : Individual level – life cycle approach
• Healthy eating• Oral health• Substance use – drug abuse, alcohol, tobacco• Physical activity and exercise• Stress reduction• Healthy sex• Healthy elderly
Health Promotion in Medical Curriculum, PSU
Examples of Core ContentExamples of Core Content• Health promotion : Organization level
• Healthy workplace• Healthy city• Health promoting hospital
• Health promotion : Community level• Health reform• People empowerment• Social movement• Civil society• Alternative medicine
Health Promotion in Medical Curriculum, PSU
• Health promotion : Community level• Health reform• People empowerment• Social movement• Civil society• Alternative medicine
HP in Preclinical teachingHP in Preclinical teaching• Topics related to health
Health Promotion in Medical Curriculum, PSU
Anatomy Musculoskeleton – Working posture Osteoarthritis
Accidents - fractureCardiovascular – Coronary heart diseaseRespiratory – Occupation lung disease Smoking, COPD
HP in Preclinical teachingHP in Preclinical teaching• Topics related to health
Health Promotion in Medical Curriculum, PSU
Physiology Blood pressure – HypertensionExerciseMenopause, Aging processBiochemistry Carbohydrate metabolism – DMLipid metabolism – DyslipidemiaCalcium metabolism – OsteoporosisNutrition - Obesity
HP in Preclinical teachingHP in Preclinical teaching• Topics related to health
Health Promotion in Medical Curriculum, PSU
Genetics Prenatal diagnosisGenetic counselingGMO
MicrobiologyAIDSHygienic controlInfection controlBiological terrorismParasitic infectionSARS, Avian flu
HP in Preclinical teachingHP in Preclinical teaching• Topics related to health
Health Promotion in Medical Curriculum, PSU
Pharmacology Rational use of drugsHerbal medicines
Pathology Pathogenesis of diseases
Miscellaneous Hazardous risk management in LabHealthy learning
Skills in Health PromotionSkills in Health Promotion• Social skills• Communication skills• Negotiation & empowerment skills• Research skills• Epidemiology skills• Professional (clinical) skills • Counseling skills• Education skills• …………………
Health Promotion in Medical Curriculum, PSU
How to TeachHow to Teach• Separate or integrated teaching• Issues of number of hour available, number of subjects taught• Educational strategies• Create learning environment Extra(supporting)-curricular activities• How to integrate with existing curricula• Start with students’ own lifestyle
Health Promotion in Medical Curriculum, PSU
ContentContent- based Education- based Education
Yr 1
Yr 2
Yr 3
Yr 4
Yr 5
Yr 6
Content 1
Content 2
Content 3
Content 4
.
Content nHealth Promotion in Medical Curriculum, PSU
- Outcome based Education- Outcome based Education
Yr 1
Yr 2
Yr 3
Yr 4
Yr 5
Yr 6
Competency 1
Competency 2
Competency 3
Competency 4
.
Competency nHealth Promotion in Medical Curriculum, PSU
Putting Health Promotion into the Curriculum
Putting Health Promotion into the Curriculum
• Unfamiliar to medical students, as well as teachers• A hybrid/integrated discipline
Social sciences (Sociology, Social policy, psychology)
Medical sciences (Including Epidemiology, Biostatistic)• Not only function of Community Medicine• Inadequate body of knowledge/experiences
Health Promotion in Medical Curriculum, PSU
Putting Health Promotion into the Curriculum
Putting Health Promotion into the Curriculum
• Specialist (expert) can teach HP• Incorporate health-promotion principles in learning approaches• Use practical vignettes enables students to identify key characteristics of health promotion• Practical and concrete illustrations of the potential of health promotion
Health Promotion in Medical Curriculum, PSU
• Promote students’ healthStarts with their own needsEncourages collaborative workingDevelops their personal skillsProvide safe and secure environment in which to practise new skills and approaches
Health Promotion in Medical Curriculum, PSU
Putting Health Promotion into the Curriculum
Putting Health Promotion into the Curriculum
Improving HP TeachingImproving HP Teaching• Role of institution• Creating HP environment• Staff development/Role model• Multidisciplinary and multiprofessional approach• Concrete real-life experiences• Integrating HP into various clinical specialties • Research for body of knowledge
Health Promotion in Medical Curriculum, PSU
Health Promotion in Medical Curriculum, PSU