Actions and Plans Actions and Plans to achieve and to achieve and

maintain healthmaintain healthChapter 6Chapter 6

What do we mean by health What do we mean by health promotion?promotion?

Health promotion is the process of enabling people to increase Health promotion is the process of enabling people to increase control over their health and improve their health. control over their health and improve their health.

Health promotion is all about prevention rather than treating an Health promotion is all about prevention rather than treating an illness.illness.

Provides resources and opportunities for people to achieve positive Provides resources and opportunities for people to achieve positive health.health.

Includes school and community health education.Includes school and community health education. Provides equal access to health and physical activity resources for Provides equal access to health and physical activity resources for

everyone.everyone. It includes legislation, policies and economic conditions to protect It includes legislation, policies and economic conditions to protect

people from harm.people from harm. In 1977 the ‘Health for all’ strategy was developed which aimed at In 1977 the ‘Health for all’ strategy was developed which aimed at

all governments around the world to aim for better health by 2000all governments around the world to aim for better health by 2000 To Help this work the To Help this work the Ottawa Charter for health PromotionOttawa Charter for health Promotion

(never forget this ever) document was developed in 1986. This is one (never forget this ever) document was developed in 1986. This is one of the most important documents in the history of health promotion.of the most important documents in the history of health promotion.

The Ottawa Charter action areas are essential to any health The Ottawa Charter action areas are essential to any health promotion worldwide. THEY ARE ALL BASED ON THE IDEA THAT promotion worldwide. THEY ARE ALL BASED ON THE IDEA THAT HEALTH IS SOCIALLY DETERMINED.HEALTH IS SOCIALLY DETERMINED.

The Ottawa Charter is a global approach organised by the World The Ottawa Charter is a global approach organised by the World Health Organisation.Health Organisation.

ACTION AREAS OF THE OTTAWA CHARTERACTION AREAS OF THE OTTAWA CHARTERThese actions were developed to improve health and create greater These actions were developed to improve health and create greater

equality in health.equality in health.(Learn these of by heart)(Learn these of by heart)--Developing personal skillsDeveloping personal skillsThis will be achieved through, provision of information. Education for

health and the enhancement of life skills. It aims to increase the individuals ability to make decisions.

These skills are developed in schools, workplaces and other community settings.

Skills are; Communication, problem solving, planning, decision making, conflict resolution, goal setting. These skills allow the individual to seek information, individual empowerment and self reliance (autonomy) They allow the individual to respond well to changes and adjustments that occur in our lives.

EMPOWERMENT: means an individual is aware of the choices they have and can make decisions without relying on others.

CREATING SUPPORTIVE ENVIRONMENTSCREATING SUPPORTIVE ENVIRONMENTS:: This area focuses on the areas where people This area focuses on the areas where people

live, work and play. It focuses on improving live, work and play. It focuses on improving peoples health promoting choices in certain peoples health promoting choices in certain areas. Eg, homeless in the city. Eg by areas. Eg, homeless in the city. Eg by providing safe playing areas for children to providing safe playing areas for children to exercise.exercise.

It focuses on our social and physical It focuses on our social and physical environments. Workplaces, support groups, environments. Workplaces, support groups, health services, schools, the media and families health services, schools, the media and families can all help to provide supportive can all help to provide supportive environments. E.g no smoking in the workplace environments. E.g no smoking in the workplace and policing toxic waste.and policing toxic waste.

STRENTHENING COMMUNITY ACTION:STRENTHENING COMMUNITY ACTION: The aim is to empower communities to The aim is to empower communities to

identify and implement actions to address identify and implement actions to address their health concerns. their health concerns.

It is a positive if communities can make It is a positive if communities can make decisions, plan strategies and impelement decisions, plan strategies and impelement them for their own health promotion.them for their own health promotion.

E.g, workplaces, schools, self help groups, E.g, workplaces, schools, self help groups, local goverments, community health centres, local goverments, community health centres, doctors, and media groups. Such as WAAT doctors, and media groups. Such as WAAT centre, health promoting schools programs centre, health promoting schools programs and ‘Go for 2 and 5’ promotion and ‘Go for 2 and 5’ promotion

REORIENTING HEALTH SERVICES:REORIENTING HEALTH SERVICES: The focus and delivery of health services

has moved away from traditional aspects of health; diagnosis, treatment and rehabilitation. It now focuses on the whole person by promoting health, preventing ill health and supporting wellbeing. This requires a change in attitude from all who deal with health.

Eg The national heart foundation and the cancer council.

Eg in schools, jump rope for heart, and healthy canteen strategy.

BUILDING HEALTHY PUBLIC POLICY:BUILDING HEALTHY PUBLIC POLICY: This relates to all decisions made at all This relates to all decisions made at all

government levels. It involves the housing government levels. It involves the housing department, health sector, employment, department, health sector, employment, finance, anything really that somehow may finance, anything really that somehow may end up affecting health. By all sectors working end up affecting health. By all sectors working together then it is easier for people to make together then it is easier for people to make quality decisions about their health.quality decisions about their health.

E.g alcopops, compulsory seatbelts, E.g alcopops, compulsory seatbelts, nutritional labeling on food, oh&s and sun nutritional labeling on food, oh&s and sun safety programs.safety programs.

Now lets look at the HIV ACTION Now lets look at the HIV ACTION plan from 1989 to 1995plan from 1989 to 1995

ANALYSING ACTIONS FOR IMPROVING PERSONAL HEALTH:ANALYSING ACTIONS FOR IMPROVING PERSONAL HEALTH: In addressing any of the topics covered so far, nutrition, physical In addressing any of the topics covered so far, nutrition, physical

activity, drug use and relationships we need to recognise that activity, drug use and relationships we need to recognise that individual decisions, policies, environments, community action and individual decisions, policies, environments, community action and access to health services all interact to improve health. access to health services all interact to improve health.

Within each of the above mentioned topics we can Within each of the above mentioned topics we can -identify skills needed-identify skills needed-question and examine what we can do to create supportive -question and examine what we can do to create supportive

environmentsenvironments-recognise how health policies can promote or harm our health in -recognise how health policies can promote or harm our health in

each area.each area.Now have a look at an example of nutrition being promoted through Now have a look at an example of nutrition being promoted through

the 5 different areas.the 5 different areas.

THREE ACTION AREAS NEED TO BE THE FOCUS WHEN THREE ACTION AREAS NEED TO BE THE FOCUS WHEN INVESTIGATING THE ABOVE TOPICS; developing personal skills, INVESTIGATING THE ABOVE TOPICS; developing personal skills, creating supportive environments and strengthening community creating supportive environments and strengthening community action. Through these we can make the most changes to individual action. Through these we can make the most changes to individual and community health.and community health.

ESTABLISHING AN ACTION PLAN TO OPTIMISE ESTABLISHING AN ACTION PLAN TO OPTIMISE HEALTHHEALTH

Motivating people to change any type of behaviour Motivating people to change any type of behaviour is a complex process. Especially if this means is a complex process. Especially if this means changing negative actions into postive ones.changing negative actions into postive ones.

To make these changes we need to look at spiral To make these changes we need to look at spiral models. (people can enter or exit at any stage)models. (people can enter or exit at any stage)

Before change can happen however the person Before change can happen however the person needs to be ready for the change to happen.needs to be ready for the change to happen.

We need to understand why we want change and We need to understand why we want change and where we are heading. (eg our goals)where we are heading. (eg our goals)

We must enjoy the results of the change to maintain We must enjoy the results of the change to maintain our action.our action.

Spiral modelSpiral model

Pre ContemplationPre Contemplation Aware of the Aware of the

health health consequences but consequences but not yet thinking not yet thinking about changing about changing that behaviourthat behaviour

ContemplationContemplation Aware of the Aware of the

problem and problem and thinking about thinking about changing the changing the problemproblem

Spiral modelSpiral model

Preparing for Preparing for actionaction

Intending to take Intending to take action within the action within the next monthnext month

Starts to make Starts to make small changes in small changes in preperationpreperation

ActionAction Begun to modify Begun to modify

behaviour, behaviour, experiences or experiences or environmentenvironment

Coping skills are Coping skills are very importantvery important

At any time during those four steps the person can relapse back to another level. They At any time during those four steps the person can relapse back to another level. They fail.fail.

Or they maintain the results they have achieved.Or they maintain the results they have achieved.

To design any action plan the following elements are necessaryTo design any action plan the following elements are necessary-short term and long term goals-short term and long term goals-a timeline-a timeline-a support network-a support network-contract or agreement for change.-contract or agreement for change.

ACTION PLANS;ACTION PLANS;-First we need to decide what we want to change and that needs to be specific, e.g loose -First we need to decide what we want to change and that needs to be specific, e.g loose

weight, for self confidence or mobility or to fit some new jeans.weight, for self confidence or mobility or to fit some new jeans.-Secondly we need to set short and long term goals so as to give us direction and -Secondly we need to set short and long term goals so as to give us direction and

something to work towards. Short term- weeks Long term – months to years.something to work towards. Short term- weeks Long term – months to years.Goals when achieved make us feel good and therefore move us towards more change.Goals when achieved make us feel good and therefore move us towards more change.Look at the handout ten hints for goal setting.Look at the handout ten hints for goal setting.SHORT TERM – SMARTSHORT TERM – SMARTSPECIFIC:SPECIFIC:MEASURABLE:MEASURABLE:ACHIEVABLE:ACHIEVABLE:REALISTIC:REALISTIC:TIME FRAME:TIME FRAME:

LONG TERM: LONG TERM: POSITIVE AND SHOULD PROVIDE INCENTIVESPOSITIVE AND SHOULD PROVIDE INCENTIVESHAVE A CLEAR TIMEFRAMEHAVE A CLEAR TIMEFRAMEBE PERSONALBE PERSONAL

Thirdly we need a timeline for the implementation. A Thirdly we need a timeline for the implementation. A timeline requires flexibility so as the plan can be timeline requires flexibility so as the plan can be adapted when needed.adapted when needed.

Fourthly we need to gain support or a support Fourthly we need to gain support or a support network; This includes social networks, family and network; This includes social networks, family and environment. This includes external incentives, environment. This includes external incentives, internal incentives, planning, communicating with internal incentives, planning, communicating with others, school programs, role models, and others, school programs, role models, and professional help, such as quite or doctors.professional help, such as quite or doctors.

There is always the possibility that we may drift back There is always the possibility that we may drift back to the old ways so we trust in our support networks to the old ways so we trust in our support networks to prop us up in those times.to prop us up in those times.

Lastly we need to get a contract that will bind us to Lastly we need to get a contract that will bind us to the change. This can be informal or formal.the change. This can be informal or formal.

THE DEGREE OF CONTROL INDIVIDUALS CAN THE DEGREE OF CONTROL INDIVIDUALS CAN EXERT OVER THEIR HEALTHEXERT OVER THEIR HEALTH::

We only have control over our health when we believe We only have control over our health when we believe we can acquire info, make choices, manage a situation we can acquire info, make choices, manage a situation that may be threatening and use the skills we have.that may be threatening and use the skills we have.

The environment can impact health in negative or The environment can impact health in negative or positive ways and we can impact on our environment in positive ways and we can impact on our environment in positive ways to improve health.positive ways to improve health.

Some people need to avoid certain environments so Some people need to avoid certain environments so they can avoid certain damaging behaviors' like they can avoid certain damaging behaviors' like smoking or (pubs) drinking.smoking or (pubs) drinking.

HOPEFULLY YOU CAN REMEMBER ‘SELF EFFICACY’ HOPEFULLY YOU CAN REMEMBER ‘SELF EFFICACY’ and what it means. Self efficacy empowers the person and what it means. Self efficacy empowers the person to make decisions and helps with self esteem. If Self to make decisions and helps with self esteem. If Self efficacy is high then that individuals control over their efficacy is high then that individuals control over their health.health.

Factors affecting health decisions:Factors affecting health decisions: Our health choices and actions are Our health choices and actions are

influenced by a number of variables. influenced by a number of variables. (HAM) is the health action model that (HAM) is the health action model that shows how we make decsions about shows how we make decsions about health.health.

Lets look at the model.Lets look at the model. As you can see the model works on 2 As you can see the model works on 2

different sections that include (next page)different sections that include (next page)

Beliefs, motivation Beliefs, motivation and social norms: and social norms: These interact to These interact to influence our influence our intentions to act in intentions to act in a certain situation. a certain situation.

Facilitating or Facilitating or inhibiting factors: inhibiting factors: These two act to These two act to support the support the decision to act on decision to act on health.health.

Ok lets run through the models parts.Ok lets run through the models parts. Beliefs: Beliefs are closely associated with our self efficacy Beliefs: Beliefs are closely associated with our self efficacy

and relate to our control over certain health issues. E.G and relate to our control over certain health issues. E.G beliefs on risk taking or drug taking. Beliefs are our general beliefs on risk taking or drug taking. Beliefs are our general motivation to act on a health problem.motivation to act on a health problem.

Motivation: Motivation incorporates personal drives (eg Motivation: Motivation incorporates personal drives (eg hunger, sex, pain, guilt or passion) and relies on our hunger, sex, pain, guilt or passion) and relies on our attitudes and values. Eg So the attitudes that have been attitudes and values. Eg So the attitudes that have been instilled in you from an early age will influence much of your instilled in you from an early age will influence much of your decision making in regards to health.decision making in regards to health.

Social Norms: Come from our social environment. They are Social Norms: Come from our social environment. They are behaviours that cause conformity. Eg, 18behaviours that cause conformity. Eg, 18thth bday parties, you bday parties, you must drink. After formal parties. Social norms come from our must drink. After formal parties. Social norms come from our friends, groups we hang around, community networks, and friends, groups we hang around, community networks, and general social behaviours. Eg (having sex before marriage or general social behaviours. Eg (having sex before marriage or not) Don’t forget role models here as well (you only need to not) Don’t forget role models here as well (you only need to look at corey on big brother at the moment, what sort of role look at corey on big brother at the moment, what sort of role model is corey to Australian Teenagers. )model is corey to Australian Teenagers. )

Facilitating or inhibiting factors:Facilitating or inhibiting factors: There are always barriers to someone making that change There are always barriers to someone making that change

in their health that is required. E.g. ( a person with in their health that is required. E.g. ( a person with diabetes giving up coke???? What's the barrier?)diabetes giving up coke???? What's the barrier?)

Eg a environmental barrier to having safe sex may be a Eg a environmental barrier to having safe sex may be a lack of access to buying a condom in country areas.lack of access to buying a condom in country areas.

Eg a personal promotion or facilitator may be the skills to Eg a personal promotion or facilitator may be the skills to put a condom on with the knowledge of contraception. put a condom on with the knowledge of contraception.

The Decision:The Decision: Environmental and personal factors are Environmental and personal factors are really significant so if the experience is positive then the really significant so if the experience is positive then the behaviour will be followed again. If failure is experienced behaviour will be followed again. If failure is experienced then the decision will be very difficult to make again. If it is then the decision will be very difficult to make again. If it is a single choice then it will more effected by a persuasive a single choice then it will more effected by a persuasive pressures.pressures.

SELF ESTEEM: PLAYS A MASSIVE ROLE IN THIS MODEL SELF ESTEEM: PLAYS A MASSIVE ROLE IN THIS MODEL THROUGH SUCCESS AND OTHER PEOPLES OPIONIONS.THROUGH SUCCESS AND OTHER PEOPLES OPIONIONS.

FACTORS WE HAVE NO CONTROL OVER: FACTORS WE HAVE NO CONTROL OVER: Heredity:Heredity: Socio cultural environment:Socio cultural environment: Health laws and regulationsHealth laws and regulations Geographic LocationGeographic Location MediaMedia Physical EnvironmentPhysical EnvironmentHowever no matter how much information or However no matter how much information or

health promotion that is done the individual health promotion that is done the individual does not always consider health when does not always consider health when making every day decisions.making every day decisions.

Is health determined by individuals Is health determined by individuals or by other factors?or by other factors?

If we can change an individuals If we can change an individuals decision making environment then decision making environment then that person will be more likely to that person will be more likely to improve their health. improve their health.

Remember you can’t take behaviour Remember you can’t take behaviour out of a social context.out of a social context.