Health, Health Promotion and Health Education

What is health?

Health is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity (WHO, 1946). Health is simply a state of wellbeing in different dimensions (physical, mental, social, financial, spiritual wellbeing etc)
It is a fundamental human right and this right is protected by law.
A vital resource for development: Health is wealth and wealth is also health.
State of balance or homoeostasis between man and his environment

Models of Health

There are three models and each one is a partial explanation of health:

Biomedical model
Behavioural model
Socio-environmental model

1. Biomedical model

This model views health as the absence of diseases or disorders such as hypertension, diabetes, asthma, and headache.

2. Behavioural Model

Behavioural model views health as the product of making healthy lifestyle choices. Such choices include smoking, diet, physical inactivity, lack of life skills, and substance abuse.

3. Socio-environmental Model

This model views health as the product of social, economic and environmental determinants that provide incentives and barriers to the health of individuals and communities. These include poverty, unemployment, environmental pollution and hazardous living and working conditions.

The Triangular Model

Habits

Smoking
Drinking
Exercise
Driving
Drug Abuse
Diet
Sexual Habits

Habitat (Environment)

Physical: Temperature, Humidity, Radiation, Noise, and Pollution Biological: Rodents, Insects, Protozoa, Bacteria, Viruses, and Fungi Social: Education, Culture, Income, Housing, Food Supply, Water Supply Psychological: Stress
Political: Political Will and Policies
Note: The habitat has more impact on the health of communities/populations than habits. The Western countries were able to achieve high life expectancy long before the discovery of antibiotics because they practiced environmental sanitation. DDT was used to eradicate plasmodium carrying mosquitoes for instance. However, the West now experiences epidemiological transition, were they have migrated from diseases of poor environmental sanitation to diseases of lifestyle. Sub-Saharan Africa stills grapples with high burdens of both diseases of poor environment and those of unhealthy lifestyle changes.

Culture and Health

Cultural practices can enhance or worsen health. Public health education promotes useful cultural practices and discourages the harmful ones.

Harmful Cultural Practices Include:

Female circumcision
Nutritional taboos
Early marriages and teenage births
Marriages between close relations
Wife hospitality
Wife inheritance

Useful Cultural Practices Include:

Breast feeding
Prolonged sexual abstinence after delivery
Low salt and non-salt diets
Vegetarian diets

What is Public Health?

Public health is the science and art of promoting health, preventing disease, and prolonging life through the organized efforts of society.
The focus of public health approach is on populations as opposed to medical care that focuses on diagnosing and treating individuals.

Population

Residents of a specific geographic area or political division (e.g. state or city). Individuals who share common characteristics (e.g. over age 65). Residents in the service area of a clinic or hospital

Indicators of Population Health

These are used to compare health across populations.

Life expectancy
Infant mortality
Morbidity
Mortality
Median age

Life Expectancy and Infant Mortality

Life expectancy is the average number of years that a person can expect to live at a given age, usually birth, based on current death rates.
Infant mortality is the number of deaths of infants less than 1 year of age, calculated per 1000 live births.
Life expectancy and infant mortality are related:
High infant mortality will result in low life expectancy from birth.

Morbidity

Morbidity describes the level of disease in a population Morbidity may be expressed as a percentage of the population e.g., 66% of the US populations are overweight or obese Prevalence – Old + New Cases of a Disease
Incidence – New Cases of a Disease

Mortality Rate

Mortality describes the number of people who die every year. Mortality is usually reported per 100,000 population
Mortality is usually standardized so that mortality rates can be compared across populations. Example—the mortality rate for cancer in Bolivia is 256 per 100,000 population and for Denmark, is 167 per 100,000 population

Scope of Public Health Professionals

Public health activities are multidisciplinary and several professionals beyond the health sector are involved:
• Doctors
• Nurses
• Pharmacists
• Dentists
• Engineers
• Economists
• Biostatisticians
• Nutritionists
• Health educators etc

Scope of Public Health Discipline

• Epidemiology- A branch as well as a tool
• Health education – a tool
• Public health nutrition
• Primary health care
• Maternal and child care
• Occupational health
• Accidents (industrial, domestic, traffic) and safety
• School, Port, International health
• Environmental health
• Mental health
• Biostatistics etc

Role of Public Health

• Prevents epidemics and the spread of disease
Protects against environmental hazards
Prevents injuries
Promotes and encourages healthy behaviors.Responds to disasters and assists communities in recovery
Assures the quality and accessibility of health services

Public Health Pharmacy

Public health is the science and art of promoting health, preventing disease, and prolonging life through the organized efforts of society. Public health pharmacy deals with the involvement of pharmacists in public health. Some call the discipline pharmaceutical public health.
The focus of public health approach is on communities as opposed to medical care that focuses on diagnosing and treating individuals.

Relationship Between Public Health and Pharmacy

• Public health and pharmacy have been closely associated for millennia
They share common symbol – The Bowl of Hygeia
The Hygeia, Greek mythological goddess of health represented as holding a large bowl and a snake. The bowl of Hygeia is a universally recognized symbol for pharmacy and public health
Health, hygiene and pharmacy are inextricably linked.

Where is the public health pharmacist?

• Public health is an emerging trend in the society
There are public health physicians and public health nurses
Do we have public health pharmacists?
There are certainly pharmacists engaged in public health activities, may be not called public health pharmacists

Challenges of Public Health Pharmacy

Pharmacy education that focuses on drug products and biomedical sciences (treatment of diseases)
Lack of early exposure to theory and practice of public health (many pharmacy schools do not have public health pharmacy as a stand a alone course)
Lack of department of public health pharmacy as we have in medicine and nursing. The PSN Education Summit in 2012 recommended the expansion of departments in pharmacy faculties to include: Public Health Pharmacy, Social & Administrative Pharmacy, and Agricultural & Veterinary Pharmacy. However, The West African Postgraduate College of Pharmacists introduced Faculty of Public Health Pharmacy in 2010. Fellows of this Faculty are by training Public Health Pharmacists.
Lack of role models to mentor young ones
Lack of definition of role of pharmacists in public health. Pharmacists engaged in public health derive strength from the product-oriented role. There are certainly some aspects of public health that are pharmaceutical in nature, in addition to the common grounds for all comers in public health. These pharmaceutically derivable areas include: Logistics & Supply Chain Management, Immunization, Pharmacoepidemiology, & Pharmacoeconomics.

Stratification of Public Health Pharmacy

1. Macrolevel

Planning/Policy making stage. Pharmacists working in the relevant Ministries, Departments, and Agencies (MDAs) as well as NGOs.

2. Microlevel

Provider or implementation. Community and hospital pharmacists who interact with populations of patients/groups (HIV/AIDS, diabetes, hypertension, elderly, school children, market women, community dwellers etc)

Health Promotion

Health promotion is the process of enabling people to exert control over the determinants (habits and environment) of health and thereby improve or maintain their health.

Health Promotion Model

1. Health Protection

Concerned with public policy and social change (The laws and policies that promote public health)
Governments at all levels enact laws; formulate regulations and policies that provide a legal/regulatory framework for health promotion.

Public health laws include: the control of diseases through:

Vaccination
Quarantine
Pollution control e.g. no smoking in public
Environmental sanitation
Birth and death registration
Disease notification
Workmen compensation
Laws on international health
Control of illicit drug use

2. Disease Prevention

Measures taken to inhibit development of a disease before it occurs or to interrupt it after it has occurred
Levels of disease prevention:

Primordial
Primary
Secondary
Tertiary prevention

1. Primordial Prevention

This arises from the epidemiological finding that some cultural patterns account for low prevalence or occurrence of certain diseases. The occurrence of death arising from coronary heart diseases is low among some Asians despite the existence of other risk factors such as smoking. This is attributable to their diet low in saturated fats over centuries.

2. Primary Prevention

Immunization and adopting healthy lifestyles

3. Secondary Prevention

Early detection/diagnosis and prompt treatment, reduces spread of infectious diseases and complications or progression of certain chronic diseases; relapse prevention in mental disorder; post- exposure prophylaxis

4. Tertiary Prevention

Reducing the impact of disability and optimizing residual functioning e.g. occupational rehabilitation and use of artificial limbs (prostheses), wheel chairs and walking sticks to aid movement are different tertiary prevention measures.

Primary Prevention (Immunization)

Immunization of adults and children is a cost-effective method of disease prevention.

Pharmacists’ role includes:

Educator (Advocacy) – benefits and risks, responding to specific questions, identifying those in need of specific immunizations
Facilitator – Distribution and cold chain management, hosting immunizers in the pharmacy
Immunizers – adults, where practice permits

The aim of pharmacists’ involvement is to improve access to immunization as practiced in 50 of the United States of America.

Vaccine Preventable Diseases

Anthrax
Cervical cancer
Pneumococcal infection
Poliomyelitis
Rabies
Rotavirus
Rubella shingles
Small pox
Tetanus
Measles
Yellow fever
Pertussis
Cholera
Diphtheria
Hepatitis A and B
Influenza (seasonal)
Haemophilus influenza type B
Japanese encephalitis
Meningococcal Infection

Primary Prevention (Lifestyle Modification)

Chronic diseases are the major cause of death and disability worldwide:

Cardiovascular – heart disease and
stroke
Cancer
Chronic respiratory diseases
Diabetes

Three well known modifiable risk factors are:

Unhealthy diet
Physical inactivity
Tobacco use
Intermediate modifiable risk factors are:
Raised blood pressure
Raised blood glucose
Raised blood lipids
Overweight/Obesity

Health Education

Health Education is a process of empowering people with relevant knowledge and skills required for informed decisions to promote and maintain health. Health education brings about:

Empowerment
Self efficacy to help oneself

Domains of Health Education

There are three domains of health education:

Cognitive
Affective
Action

Objectives of health education

To improve knowledge and skills – cognitive
To develop positive attitudes, values, and beliefs – affective
To enhance positive behavioral changes – action

1. Cognitive Domain

This refers to the factual information arranged into six levels: From simple to complex

Knowledge
Comprehension (understanding)
Application
Analysis
Synthesis
Evaluation

2. Affective Domain includes:

Attitudes
Beliefs
Perceptions
Values

These influence life choices.

3. Action Domain

This pertains to the psychomotor activities i.e. behaviours/practices that individuals pursue in order to satisfy their desires.

Methods and Techniques of Health Education

Education involves learning and there can be individual and group learning.
Evidence suggests that group learning is more effective than individual learning.
Furthermore learning is reinforced when various senses are engaged
Therefore, in addition to verbal information, the use of audio-visuals and printed materials is beneficial
Today, modern technology is employed to improve access to health information: radio, television, newspapers, posters and the Internet.

Health Promotion Interventions

Exercise and fitness
After food and water, we should exercise regularly to keep healthy.

Categories of Physical Exercise

Endurance
Strength
Balance
Flexibility

Endurance, or aerobic activities increase breathing and heart rate; improve heart and lung function and delay or prevent several chronic diseases. Examples are:

Brisk walking or jogging
Yard work (mowing, raking, digging)
Dancing
Swimming
Biking
Climbing stairs or hills
Playing tennis
Playing basketball

Strength (Resistance) exercises build and make muscles stronger; anaerobic and unsuitable in heart problems. Examples include:

Lifting weights
Using a resistance band

Balance exercises help prevent falls, a common problem in older adults. Many lower-body strength exercises also will improve balance. Examples of balance exercises include

Standing on one foot
Heel-to-toe walk

Flexibility exercises stretch muscles and can help body stay limber; gives you more freedom of movement for other exercises and daily activities. Examples of Flexibility exercises include:

Shoulder and upper arm stretch
Calf stretch