Unit 3: Health Promotion

and Diversity
Health Promotion
 Health promotion:
A strategy to improve health
 The Ottawa Charter (1986) defined it as
“enabling people to increase control over and
to improve their health.” (building capacity)
 This
was the beginning of the conceptualization
of empowerment as a component of health
promotion.
Definitions of Health/Development of
Health Promotion
Health used to be defined as “absence of disease”
Health………………………………………………………………..Illness
WHO (1947) “health is a state of complete physical,
mental, and social well-being, and not merely the absence
of disease or infirmity”
WHO (1986) “positive resource for everyday living that is
holistic…”
Health, as a resource, allows clients to live life to its fullest
potential and thus can use this resource to manage their
surroundings
Health Promotion, Disease Prevention,
Harm Reduction
 Disease Prevention Involves 3 levels of prevention
 Prevents occurrence of disease, detects and stops disease in
those at risk, reduces negative effects of disease
 Health promotion WHO (2005) redefined the term
 Process of enabling people to increase control over the
determinants of health and thereby improve their health.
 Harm Reduction Policies or programs that decrease
substance use. Abstinence is not a pre-requisite of being
in a program but would be the final goal
Determinants of Health and Health
Promotion-Review
 LALONDE 1974 – determinants of health were
“Biology, environment and lifestyle”
 Many more determinants identified since 1974
 Policymakers increased their awareness of the
importance of health promotion.
 Previously medical model prevailed with heavy
focus on illness
 Evolution of Health Promotion
 WHO(1984)-developed 5 principles of health
promotion.
 Ottawa Charter of Health (1986)-increased awareness
of and expanded upon the determinants of health &
strategies for health promotion .
 EppReport (1986)-proposed a national framework for
health promotion:
 and identified 3 national health challenges:
Health Promotion Approaches
 Biomedical – focus is on treatment and prevention
of disease
 Behavioural – (came out of Lalonde Report (1974)
focus is on lifestyle changes to promote health
 Socioenvironmental (came out of Alma-Ata
conference on Primary Health Care in 1978) –
states that community participation &
intersectoral collaboration necessary for dealing
with psychosocial and environmental
determinants of health. HEALTH IS SEEN AS A
RESOURCE
Health Promotion Model
3 dimensional model
 Interrelating parts that guide actions to improve
health
 1. What?-looks at the health determinants
 2.Who?-looks at the different levels we are
working with (community)
 3. How?-the health promotion strategies that are
used to act on the health determinants. These
are 5 strategies from the Ottawa Charter
“Action areas” also referred to as
“Health Promotion strategies
 1986 – shift from individual based health promotion approach toward
population health promotion that integrated Ottawa Charter.
 5 major “action” areas identified
 1. Healthy Public Policy (eg mandatory seat belts in cars)
 2. Supportive environments (smoke free workplace)
 3.Strengthening community action (funding for health initiatives
such as heart health and healthy food choices in restaurants
 4.Developing personal skills (adult literacy program)
 5.Reorienting health services(creating interdisciplinary community
health centres
Population Health Model

 Who: levels within society where

action can be taken
 What: on what can we take action?
(determinants of health)
 How: Ottawa charter action
strategies
 Why: take action using research &
evidence; collaborate with
community
 Health Promotion Strategies
1. Strengthening Community Action
Community development- Capacity building
focus on
engaging the community members to strengths:
services
participate in health care decisions resources
programs
Partnering to identify issues, organize, Empowerment
active
plan and work together to make changes development
Community
involvement
take charge of
that enhance health by managing strategies
effects of the determinants.
Strengthen
Community
Action
 Health Promotion Strategies
2. Creating Supportive Environments
 Reciprocal Maintenance – taking care of:
 each other
 our communities
 our environment
 Goals:
-healthy and safe physical environments
-living & working conditions are satisfying
- natural environments & resources conserved
Health Promotion Strategies

3. Develop personal health skills

 that enhance ability to cope and gain control over health and
environment. = Empowerment & Involvement

 Examples – health education, stress mgmt., healthy eating, early intervention

programs, parenting classes, newborn home visits, literacy support, job
training.
 Health Promotion Strategies

4. Reorient Health Services

Shift from “treating disease” to considering:
 links between the determinants of health and population health
 social justice (equity) the individual as a holistic being;
 community-based care that is accessible, affordable,
acceptable, and appropriate for the clients;
a greater focus on population health and on health research; and
modifications to professional education.
Health Promotion Strategies
5. Healthy Public Policy
 Policy that has a positive effect on or promotes
health
 Building healthy public policy:
 Creating environments that support health and
reduce inequities in health and social policies
Compare & Contrast the Application of
Risk Reduction & Capacity Building
Capacity Building Risk Reduction
 specific services, resources and  is a disease prevention strategy
programs that can assist
communities, individuals or  Reduces or alters health
organizations to deal with their concerns
health issues  Disease detected and treated
 Involves community members early
taking action
 Requires
 Most often used with clients
social and political
with substance abuse eg
support to implement programs
alcohol/drugs
 To build community capacity CHNs
need to work collaboratively with
community – increases chance of
long term success for programs
CHN Role in Health Promotion
 Communityhealth nurses (CHNs) promote health in
environmental, political, and social contexts.

 CHNs use the community health nursing process to

Assess
Plan
Intervene
Evaluate their practice on micro and macro levels
CHN’s roles and responsibilities in health
promotion
 CHN’s use many health promotion skills during
interactions with their clients when promoting
health
 Work in focus groups and prepare funding
applications
The Determinants of Health cont’d
As I read this jot down the determinants involved
Diversity and Culture
NFDN 2006
Health Promotion and Diversity Unit 3
Culture
Culture:
 Set of beliefs, values & assumptions about life held
by a group of people generation to generation
(Leininger 2002)
 Examples of cultural groups can be based on gender,
sexual orientation, geographic location, physical and
mental health challenges, religion, age, race, and
ethnicity.
Diversity:
 Refers to the uniqueness of the client within the
cultural context
 Focuses on client assets that build capacity
Culture
 Multiculturalism:
A belief that promotes the recognition of
diversity of citizens with respect to their
ancestry and supports acceptance and belonging
 CNA: nurses require knowledge, skill, attitudes &
personal attributes to provide culturally
competent care
 Cultural differences pose fundamental barriers in
health care as traditional beliefs can decrease the
use of and compliance with treatment
Culture as a Determinant of Health
 Culture is one of the 12 determinants of health.

 Some cultural groups are at an increased risk for

poor health because of marginalization,
stigmatization, and language barriers.
Culture & Cultural Groups’ Variations
Ethnicity
 has replaced the term race when assigning identity &
describing culture
 personal awareness of certain symbolic elements that bind
people together in a social context
 a social context where race is a biological concept
 represents the identifying characteristics of culture (race,
religion, national origin)
Race
 a social classification that relies on physical markers such
as skin tone to identify group membership
Cultural Characteristics
 Culture is learned based on internalized
events/experiences as we grow & develop
 Culture is adaptive to environmental & technological
changes occurring over time
 Culture is dynamic – persons respond to changes; culture is
not static
 Culture is invisible & is only evident by rituals, language,
celebrations & attire
Cultural Characteristics
 Culture is shared in that persons from the same
culture identify with the same values, beliefs,
patterns, yet remain individuals
 Culture is selective with boundaries identified for
desirable, acceptable or unacceptable behaviours
& influences how persons view & respond to
situations & issues
 Differentiates between outsiders & insiders
Competence
 performance that is sufficient & adequate
Cultural Competence
 combination of culturally congruent behaviours, practice
attitudes & policies that allow the nurse to work
effectively in cross-cultural situations
 something that occurs “in the moment”, not a constant
thing
Cultural Safety
 gaining an understanding of other’s health beliefs &
practices in order that your actions show equity, respect
& avoidance of discrimination
Developing Competence
 an ongoing life process
 Leininger – 2 principles
 maintain broad, objective & open attitudes toward
individuals & their cultures
 avoid seeing all individuals as alike
 awareness of experiences with other cultures
 promote mutual respect for all differences
 not all nurses reach the same level of development (at the
same time or ever)
Attributes of Cultural Competence
 Cultural Awareness
 Cultural Knowledge
 Cultural Understanding
 Cultural Sensitivity
 Cultural Interaction
 Cultural Skill
 Cultural Proficiency
Cultural Competence Inhibitors
Ethnocentrism
 belief that one’s own group determines the standard of behaviour for
all other groups to be judged (own culture superior to all others)
 Discrimination is a subtle form of ethnocentrism
Cultural Blindness
 ignore differences between cultures & act as though the differences
do not exist, act as though all people are the same
Culture Shock
 feeling of helplessness, discomfort & disorientation by individual in
attempting to understand or effectively adapt to another cultural
group’s different practices, values & beliefs
Cultural Competence Inhibitors
Stereotyping
 making generalizations about values, beliefs & behaviours
of a group, ignoring the uniqueness of their individuality
Prejudice
 emotional manifestation of deeply held beliefs about
other groups involving negative attitudes
Racism
 prejudice based on belief that one’s own culture is
superior to other cultural groups
Cultural Nursing Assessment
 a systematic way to identify the beliefs, values, meanings &
behaviours of people while considering their history, life experiences
& the social & physical environments in which they live
 some clients may be reluctant to acknowledge cultural identity
(background, religion, age, sexual orientation)
 According to Giger and Davidhizar’s Transcultural Assessment Model,
factors to consider during a cultural assessment include the following:
 Culturally unique individual
 Communication
 Space
 Social organization
 Time
 Biological variations
Application to CHN
 Culturally competent CHNs:
 Use cultural brokering
 Know if there are specific risk factors for a
given cultural population
 Understand their clients’ nontraditional healing
practices
 Are aware of cultural values, beliefs, and
practices to guide them in delivering culturally
appropriate care
Interventions
 Respect client’s beliefs in folk & traditional remedies
 Combine folk lore & standard practices as much as
possible. Accept the right to seek alternative therapies
 Sources of healthcare may include churches, shamans,
medicine man, faith healers
 Respect family position & gender distinctions
 Continuous use of active listening & validation
 Client is a person not a culture (cultural safety)
Interpreters in Nursing Practice

 Use an interpreter who has knowledge of health-

related terminology
 Sex of interpreter may be important
 Identify the dialect/language spoken by the client
 Clarify roles with the interpreter
 Introduce the interpreter
 Observe client for non verbals
Providing Culturally Safe Nursing Care

 http://www.youtube.com/watch?v=Dx4Ia-jatNQ
 Example of competent vs. incompetent nursing care

 http://www.youtube.com/watch?v=dNLtAj0wy6I
 Cultural Competence for Health care professionals
CHN’s and Cultural Nursing Care

 What do community health nurses need to know when completing a cultural

assessment?