Health Promotion Introduction dr. Harun Al Rasyid, MPH

Influences on health Knowledge Beliefs Culture Social influences Lifestyle and behaviour Knowledge Beliefs Culture Social influences Environment Housing/building Water/sanitation Hazardous waste Pollution Climate

Influences on health Preventative services Treatment services Health Care Preventative services Treatment services Traditional medicine Health policy Primary health care Heredity Genetic attributes

So what is health promotion. What does it aim to do. How does it do it So what is health promotion? What does it aim to do? How does it do it? Who does it?

What is health promotion? Lalonde, 1974 Suatu strategi yang ditujukan untuk memberikan informasi, mempengaruhi, dan membantu individu-individu atau kelompok agar mereka bisa memenrima tanggung jawab dan lebih aktif pada hal-hal yang mempengarhui kesehatan fisik dan mental A strategy “aimed at informing, influencing and assisting both individuals and organizations so that they will accept more responsibility and be more active in matters affecting mental and physical health”

What is health promotion? Green, 1980 Kombinasi antara pendidikan kesehatan (penyuluhan) dan intervensi-intervensi yang bersifat organisasi, politik dan ekonomi yang didesain untuk memfasilitasi perubahan perilaku dan lingkungan untuk meningkatkan (status) kesehatan Any combination of health education and related organizational, political and economic interventions designed to facilitate behavioral and environmental changes that will improve health

What is health promotion? Ottawa Charter for Health Promotion, 1986 The process of enabling people to increase control over, and to improve, their health

What is health promotion? Howatt et al., 2003 Combination of educational, organisational, economic, social and political actions designed with meaningful participation, to enable individuals, groups and whole communities to increase control over, and to improve their health through attitudinal, behavioural, social and environmental changes

Combination of actions Educational Organizational Economic Social Political

With To Enable Individuals Groups Whole communities Meaningful participation (what is this?) To Enable Individuals Groups Whole communities

to increase control over, and to improve their health Through attitudinal, behavioural, social and environmental changes.

Ottawa Charter for Health Promotion Building healthy public policy Kesehatan belum tentu menjadi agenda para pengambil kebijakan Banyak permasalahan kesehatan yang bisa diatasi melalui intervensi kebijakan Key: Legislative Action Organizational change

Ottawa Charter for Health Promotion Creating supportive environments Menciptakan kondisi tempat tinggal dan tempat kerja yang aman dan kondusif untuk perilaku sehat Key: Facilitate healthy behaviours Reduce barriers

Ottawa Charter for Health Promotion Strengthening community action Pemberdayaan masyarakat (community empowerment) Memiliki kemampuan untuk menjaga dan meningkatkan status kesehatan Key: empowerment, ownership, control

Ottawa Charter for Health Promotion Developing personal skill Biasanya aktivitas promosi kesehatan lebih banyak fokus kepada aktivitas penyuluhan kesehatan (KIE)  peningkatan pengetahuan Selain pengetahuan juga diperlukan sikap yang positif dan latihan keterampilan Key: educate for health enhance life skills

Ottawa Charter for Health Promotion Re-orienting health services Lebih menekankan pada aktivitas pencegahan Lebih memperhatikan (sensitif) pada budaya lokal  setiap daerah memiliki keunikan tersendiri sehingga bisa membutuhkan pendekatan yang berbeda Key: increase emphasis in prevention sensitive to cultural needs

------------------------- Health Promotion health education - behavioural - structural ------------------------- organisational actions economic political actions Including advocacy attitudinal behavioural environmental and social changes conducive to health Improved Health status

Settings of Health Promotion Health promotion intervention can be applied at: Family level School Workplace Public places

Theories used in Health Promotion Maslow Health Believe Model Social Cognitive Theory Diffusion of Innovation Theory

Abraham Maslow (humanistic theory) Basis: We attend to fundamental human needs first self Actualization needs self esteem needs lovely belonging needs safety needs physiological needs

Perceived susceptibility Perceived seriousness Perceived expectations Health Belief Model Perceived susceptibility to problem Perceived threat Perceived seriousness of consequences of problem Self-efficacy (perceived ability to carry out recommended action) Perceived benefits of specified action Perceived expectations Perceived barriers to taking actions Cues to action

Social Cognitive Theory (Albert Bandura 1977) Individual, environment and behaviour continuously interact and influence each other (reciprocal determinism) Key components: self- efficacy, learning though observation, reinforcement, reciprocal determinism, expectations, behavioural capability This theory is useful for individual, group, and population program development

Reciprocal determinism Environmental factors (e.g. Social norms, access to community) Cognitive factors (e.g. Expectations, attitudes) Behavioural factors, skills, practice

Diffusion of Innovation Theory (Everett Rogers) Some individuals and groups in society tend to be quicker to pick up new ideas than others. Others in the community tend to be more suspicious of change and slow to respond to ‘new-fangled’ idea (new idea but seems complicated/unnecessary)

Classification of adopters: Innovators (2-3%) quickest adopt new ideas, less-likely to be trusted by the majority of the community Early adopters (10-15%) More mainstream within community, amenable to change, have personal, social and financial resources to adopt the innovation Early majority (30-35%) amenable to change, have become persuaded of the benefits of adopting the innovation Late majority (30-35%) sceptics, reluctant to adopt ideas until the benefits have been clearly established Laggards (10-20%) the most conservative, actively resistant to new ideas

Thank You!