This paper addresses the knowledge aspect of the core competences stipulated by the European wide project that aimed at developing the competence and professional standards for health promotion practice and capacity building in Europe. This paper would be elaborate on the nine key sections, which underpins the knowledge-based competencies. Each section would be independent of the other.
In each section, the paper starts by explaining the meaning of the statement in the student's (my) own perspective, give brief definitions of some terms where applicable and discuss into detail what each section means , compare to other scholarly work, papers, speeches and conclude on a note meaningful to addressing the knowledge based competencies of health promotion.
1. Appreciation of the history and development of health promotion, including the Ottawa Charter (WHO, 1986) and successive charters and declarations, which provide the foundations for health promotion practice.
In order to appreciate the subject matter, health promotion, its definition is imperative. According to Donev, Pavlekovic, and Kragelj (2007)health promotion is defined in different ways by different researchers, scholars, and professionals before and after the Ottawa Charter. Green and Tones (2010) is of the view that prescriptive schemes and programs on health care because of how people conceptualize health. Really, there are different types of health schemes and programs available worldwide hence different ideologies on health. Green & Iverson (1982) put health promotion as "any combination of health education and related organizational, economic, and environmental supports for behaviour conducive to health". World Health Organization (WHO, 1986) defines health promotion as "The process of enabling people to increase control over and to improve their health". The differences in definitions of health promotion give a clue that the historical point of the subject matter would have different starting point by different researchers. This section acknowledges that health promotion to some extent or in different ways had existed in some years before the Ottawa Chatter but with a paradigm shift from the medical technology and individual perspective to more structural and support-based system in this 21st century, which makes healthy choices easier ones. Individuals, groups and other scholars have made great contribution to the development of health promotion practice.
Tountas (2009) show that the root of health promotion is found among the ancient Greek. Tountas (2009) makes me appreciate that the Greeks were the first to break the perception of health and spirituality; the Greeks uncovered the relationship between health, society and behaviour. In practice of health promotion in recent times, society forms an important aspect.
Thomas McKeon, according to (Mittelmark, Kickbusch, Rootman, Scriven, & Tones, 2007) also show a great clarity the extent to which improved living conditions and nutrition contributed to the increase in life expectance in the early 20th century. the Ottawa Chatter was built on many resources however according to (Mittelmark et al., 2007) the works of McKeon played a significant role in the Ottawa Chatter.
Donev et al. (2007) indicates that it is empirically evident the first National policy document used to identify health promotion as a strategic tool for National, Community, Organizational and Individual development was the Canadian document; which indicated that the importance of other determinates of health than the healthcare system. In 1977, the health for all policy stated that the social goal of governments was to achieve a level of health that would enable people in the society live productive life; this achievement was target by the year 2000 (Donev et al., 2007). The WHO declaration on Primary health care at Alma-Ata (1978) was in the right direction in the health for all movement and puts forward healthcare accessible to all.
In 1986, when the first international conference on health promotion held in Ottawa, the Ottawa Chatter was adopted (Mittelmark et al., 2007). the Ottawa Chatter was another approach to enhancing primary health care concept by empowering people who would benefit from the concepts of the primary health care at all levels. The Ottawa Chatter has been acknowledged as the bedrock of health promotion and gives five essential areas of health action which includes healthy public policies, supportive environments, personal skills, community action and reorientation of health services(World Health Organisation, 1986). This is indicative of health beyond the individual. After Ottawa, there were series of global conferences all aiming towards making health promotion a global approach and concern. The subsequent conferences that followed Ottawa Charter "explored Healthy Public Policies (Adelaide in 1988), Supportive Environments (Sundsvall in 1991), New Players in a New Era (Jakarta in 1997), Inequalities in Health (Mexico in 2000) and Globalization (Bangkok in 2005)" (Mittelmark et al., 2007).
The Nairobi Call to Action for closing the gab a recommendation from the Commission of social determinants to bridge the gap that existed in policies evidence, policy, practice, governance and political will, resulting in a failure to realize the full potential of health promotion (WHO, 2009). This is where we find ourselves now after 26 years of Ottawa Chatter the commitment to health equity remains a challenge and as advocated by (Baum, 2007) it takes the civil society with a linking social capital to put pressure on government to take action on health equity
2.Understanding of the core concepts and principles of health promotion and their application in practice
Concepts and principles guiding the practice of a discipline cannot be over emphasized. according to the Oxford Dictionaries (2012) concept is the "Philosophy , a plan or an intention, idea or mental image which corresponds to some distinct entity or class of entities, or to its essential features, or determines the application of a term (especially a predicate), and thus plays a part in the use of reason or language"(Oxford Dictionaries, 2012). The principles of health promotion helps actors at all levels to put into practice the ideologies and concepts of health promotion. A principle according to Alermi (1996) is considered an essential element or constituent of a process. Thus, principles of a process are key characteristic that separate the process from other approaches. Influential events that helped in the prominent use of the core concepts and principles of health promotion in practice included the International Conferences on Health Promotion, firstly in Ottawa and then in Adelaide Sundsvall and Jakarta (Smith, Tang, & Nutbeam, 2006)
Health for All, "is a process leading to a progressive improvement in the health of people, not a single, finite target"(World Health Organisation, 1984) as declared in the Alma-ata health for all is seen to be a focal point for many countries to strive toward getting the larger population to enjoy health. In fact it has it has "provided an aspirational goal, based on the concept of equity in health"(Nutbeam, 1998)
The principle of empowering people to reduce health inequities is a goal itself. When people are empowered, they are able to select involuntarily actions that can have positive effects on their health. the power to vested in people to choose gives an individual the access to have control their lives (Rodham, 2010). Empowerment - Empowerment is a process through which people gain greater control over the decisions and actions affecting their health (Nutbeam, 1998). In empowering people, health promotion seeks to make people to exercise greater control over the things that affect their lives through an informed decision-making.
Healthy Public policy as a concept promotes the health of individuals and communities by
• giving opportunity to people to adopt healthy lifestyle;
• preventing people to adopt unhealthy lifestyle; and also crucial is
• creating healthy physical and social environments. (Nutbeam, 1998).
According to the Health Promotion Glossary (Nutbeam, 1998), healthy public policy is a policy "characterized by an explicit concern for health and equity in all areas of policy, and by accountability for health impact". Norway in recognizing the problem of inequity in 1978, went through series of Charters and Policies making and then implementing the policies (Strand, Brown, Torgerson, & Giæver, 2009) that seriously closes the gab of social inequity in health, commendable of noting as a health promotion State.
Holistic view of health Health promotion takes on the definition by the World Health Organization, which defines health as: "a state of complete physical, mental and social well-being rather than a mere absence of disease or infirmity"(World Health Organisation, 1984). This definition regards health as "a resource for everyday life." Health promotion views health as a positive concept emphasizing social and personal resources as well as physical capabilities (World Health Organisation, 1986)
Social Justice and Equity - A large body of research has shown that poverty and income inequality are the greatest causes or determinants of health status. Simply put, low-income Canadians are more likely to die younger and suffer more illness than Canadians with higher income regardless of age, sex, race or place of residence (Cott, Gignac, & Badley, 1999). Lalonde (1974) makes us to appreciate that in the Canadian document, health was given priority not only to the number of health care systems available by trying to add years to our lives but life to our years, so that everyone can enjoy the opportunities offered in the society equally. Consequently, health promotion practice reflects a concern with social justice to ensure that everyone has equitable access to food, income, employment, shelter, education and other factors needed to maintain good health..
Inclusion - To ensure that everyone has access to the resources needed to maintain good health as well as a voice in the decisions affecting their health, health promotion practice emphasizes inclusion by working with members of marginalized groups in the community who face systemic barriers to good health.
Respect - Health promotion embodies and respects a diverse range of viewpoints, cultures and perspectives on health and wellness.
Partnership for health promotion "is a voluntary agreement between two or more partners to work cooperatively towards a set of shared health outcome"(Nutbeam, 1998). According to (Alter and Hage 1993; Lasker et al. 1997 cited in Lasker, Weiss, & Miller, 2001) p 180), "health professionals and organizations are ex-pected to do more with less, and, with the growing interest in health outcomes, many of them are being held accountable for results that are beyond their direct control" and as a result a synergy in collaboration is therefore seen as vital in achieving healthy outcomes. Through cooperation and linkage to the policies of other ministries, Norway can be said to be in the process of moving from a structured development to a comprehensive policy on social equity in health (Strand et al., 2009). This shows the power of collaboration, which is essential to health promotion practice.
Advocacy for health is a major principle in health promotion practice. Advocacy - is "a combination of individual and social actions designed to gain political commitment or support for a particular health goal or program" (WHO (1992) cited in Nutbeam, 1998) p353). Advocacy is one of the major strategies stipulates in the Ottawa chatter for health promotion. Advocacy is used in articulating the concepts of health promotion. Advocacy helps catalyze change especially in situations of unfairness and injustice(World Health Communication Associates Health Literacy Action Guide, 2010). Advocacy can take place in many forms such as the use of mass media and multi-media (Nutbeam, 1998). the publication of Baum (2007) is an advocacy document for the combined efforts of civil society and politician in "cracking the nut" of health inequity.
Value free (biomedical approach )or value laden(Boorse, Dec., 1977; Yeo, 1993)
Health Equity is a concept that comes as a result of equity."Equity means fairness.... Equity in health means that people's needs guide the distribution of opportunities for well-being" (WHO, Geneva, (1996) as cited in Nutbeam (1998) p7). health equity
enabling ent
Empowerment use of assets....is a principle
How to achieve concept is thru principles
An example of principle can be seen in MARGARET WHITEHEAD (international health promotion 1991)equity concept should be seen as enabling people to actually adopt healthy lifestyles easier than they could have
3.Understanding of the theories, research and multidisciplinary knowledge base underpining health promotion and their application in the development and implementation of health promotion practice, policy and research.
The field of Health promotion encompasses many disciplines. The field over the last two decades, has realized a growth of health professionals, social scientists, educators, and community activists (Yeo, 1993).
other practitioner have a individual view of HEPRO whereas others have a system view of HEPRO(Green and Raeburn, 1988 as cited in (Yeo, 1993)p227)). the posiiblity of the divergent proffessionals makes it a multidisciplinary field enriched with a multidisciplinary knowledge.
antonovsky's salutogenseis theory is probably the foundation underpin health promotion practice in recnt time.
4. Awareness and understanding of ethical dimensions of health promotion and their application in practice
Ethics as can be described as "the discipline concerned with what is morally good and bad, right and wrong…Its subject consists of the fundamental issues of practical decision-making" Encyclopædia Britannica as cited in Bull, Riggs, and Nchogu (2012). The Oxford English Dictionary also defines ethics "a set of moral principles or values, principles of conduct governing an institution, or an individual." Health promotion field is not a bounded field; but rather full of professionals of diverse background(Yeo, 1993). The resultant of the diverse disciplines in Health promotion emerges various definitions of health and health promotion and hence making it a value-laden. The clarity of values and concepts makes ethics important here. Once individuals are seen in this group it is imperative to have a code of ethics governing these individuals in their practice. Also, amidst different and growing cultures and diversities, society demands explicitly moral ground for Health promotion in order to have common values (Sindal, 2002). It is of no doubt that there is a growth in documentations arising from a dialogue between public health and the human rights international( Easley et al, (2002) as cited in (Sindal, 2002)p201). Other institutions and organizations have code of ethics that govern them but in the practice of health promotion, there are no code of ethics for health promotion field and the health promotion practitioners were often running into a fix hence the quest to develop one(Bull et al., 2012). Importance of code of ethics in an association, ethic in health promotion with example ethics goes with sanctions. as seen in ..(Yeo, 1993) ..is it possible to put sanctions on program mangers and practitioners if after evaluative ethics the impacts seen vis-a-vis the intervention program is not realized. then it is most likely that institutions and other agencies may redraw from intervention programs. health promotion may seam to be right in its own direction as its automatically seen as adding value to society but of cause it can also be questioned by the ethicists whether programs and initiatives are neither punitive or paternalistic.
Mittelmark (2008) explains that the ethical agenda of health promotion can be sorted out systematically into three main arena namely: the Ottawa chatter cornerstone for the ethic of health promotion, professional ethics and Research ethics. this is need for code of ethics in the field of health promotion is also expressed in the survey conducted by Bull et al. (2012) as majority (83%) of the members of The International Union for Health Promotion and Education (IUHPE) responded affirmatively that there is a need for a code of ethics. A research conducted by (Mortensen, Smith, & Cavanagh, 1989) indicated that ethics is at the heart of managers and employees at work; the ethical actions of business helps individuals in achieving organizational goals mutually. Ethics in professional practice in health promotion is evident in the concept on empowerment where societies and individuals are actually enabled to make healthy choices by themselves; here people themselves make choices without cohesion. in recent times where the field of health promotion has increasingly embraced empowerment theories Buchanan challenges the usefulness of paradigms such as these that include power, mastery and control as key underlying constructs. In critiquing empowerment theory, for example, Buchanan (2000) asks: "Why has empowerment assumed such prominence in the field these days? Of all the different candidates that could possibly be contemplated, why has the interest in power become so predominant? Why not caring, or compassion, or dignity, or love, morality, respect, harmony, responsibility, or some other significant human aspiration? Why has the pursuit of power captured so much attention?" (Buchanan, 2000, p. 81). These questions raised makes it so clear that code of ethics in health promotion is relevant.
5.Appreciation of the importance of context for health promotion practice and socio-ecological model of the settings-based approach
**use Prof
use (Rodham, 2010)
Context for health promotion can be traced as far back the Ottawa Chatter where health promotion is addressed beyond the individual level.
In an effort to promote health, the "settings-based approach" has been a central focus and this distinguishes the importance of context (Whitelaw et al., 2001)
Healthy settings: challenges to generating
evidence of effectiveness by mark dooris
6. Knowledge of the biological, behavioural and socio-environmental determinants of health and their implications for the development of effective health promotion policies and programmes
These other determinants, laid out in what
the Lalonde Report (1974)-called the "Health field concept" are
environment, biology, and lifestyle(Yeo, 1993)
7.Understanding the concepts of health inequalities and equities, their impact on health status and their relevance for health promotion policies and programmes
inequalities defnt
use health glossary 98
8. Appreciation of the impact of local, national, regional and international health systems , policies and priorities on health promotion practice
WHO, 2009 makes us to appreciate that no matter the nature of a country's health system; it should be able to make her citizens healthy through healthy public policies. Apparently People do not really care the presence of intervention programs or policies; they are so much engaged with unhealthy lifestyles. Sometimes the implementation of programs and policies do not acknowledge the environment and settings in context, hence expected results are not achieved. In Ghana for instance, the Ministry of Health (MOH), part of its health programs introduced the concept of "Regenerative Health and Nutrition (RHN)" into the country to reduce the incidence of preventable diseases and to promote regenerative health (Globalization and Health 2011)
http://www.globalizationandhealth.com/content/7/1/7
use the impact of public opinion on policy...chk the resource folder my space.
labonte et al, demonstrate that even at the global perspective, there is a significant impact on the health outcomes hence prirites on health promotion practice. There is
a premise that public policies determine the ultimate allocation of opportunities and
resources within a political jurisdiction(Labonte & Torgerson, 2005)
9. Awareness of, and sensitivity to social and cultural diversity in all aspects of health promotion practice.
The "health for all" series documents that in adoption of health for all, countries should design policies with a focus of socio-economic characteristics of countries (World Health Organisation, 1984)
social and cultural aspects of life have significant influence on the practice of healh promotion. health promotion practitioners need to be aware of these aspects of the envionment in order to have positive health outcome(Abel, 2007)
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