The Ottawa Charter: Inequality In Canada
HEALTH PROMOTION.
NAME: CHINAZOR NWOKOCHA
STD. ID: 3330731
WORD COUNT: 4077
The Ottawa Charter which was being approved by some researchers, makers of policies and practitioners came together in Canada to make a way for the countries in the WHO EURO region to pursue the Declaration of Alma Ata’s vision of “Health for All by the Year 2000” (WHO, 2011). 3 papers were cited as reminder for the Charter: the Lalonde report (1974), the Alma Ata Declaration and the optimistic meaning of health in preambles of WHO constitution (1946). The WHO constitution suggested an optimistic definition of health for the very first time as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (1946). However, …show more content…
it has been difficult to interpret this meaning of health into the society (Parrish, 2010), it still remains the most likeable and incorporative meaning of health. It creates the positive aspect of health (Kickbusch, 2007) other than the preventive adverse condition. It works as a summary to both the Alma Ata declaration and the Ottawa Charta and begins the statements that health is right of humans and the key elements that form health are societal (Mann, 1996).
2011 made it 25th year’s anniversary of Ottawa Charter for Health Promotion (WHO, 1986). Sometimes, it is presented as a document that promotes health (Hills & McQueen, 2007), but can be “tip of a much more complicated set of ideas and values” (Saan, 2007). Ottawa charter’s role was independently for public health to integrate health promotion widely. In the western world where it was developed, health promotion was known as the third revolution (Fassin, 2000), and a critical dialogue for public health. In recent times, health promotion has gone wide, not just for an individual alone but also for the community as a whole. This is supported by the Bangkok Charter which made the field of health promotion to be a global awareness by ensuring that there are commitment to be made by health professionals if they want they vision of health promotion in a community to be achieved (WHO, 2005). Therefore, the main worries of public health are to prevent diseases instead of the medicinal aspect of the disease. It deals at the population level other than at the individual levels.
The conditions in which people live have a profound influence on their health.
Difference in health between individuals and population groups exist in all societies. For example younger age population generally have good health compared to elder population. This kind of health difference cannot be concluded as health inequality because it is natural. So the question is that when the difference in health becomes inequality? According to Graham the difference in health between population groups becomes inequality when it is linked to the inequalities in their position in society (2007). World Health Organisation appointed Committee for the Social Determinates of Health (CSDH) also hold similar view as not all health inequalities are unjust or inequitable. If good health were simply unattainable, this would be unfortunate but not unjust. Where inequalities in health are avoidable, yet are not avoided, they are inequitable (2008). So the differences in health between groups having unequal position in society become an ethical …show more content…
issue.
The aims of promoting health are to optimistically enhance the behaviours of individual and the society on their health including those environmental and social factors that could affect their health negatively. Usually, the environment where a person lives is very vital for both the status of his health and quality of Life. It was recognized gradually that maintenance and improvement of health is not only via the progress and application of health science, but via healthy lifestyle choices made by an individual and the society as a whole. Although, the determinants of health according to WHO (2002) which could be economic and social environment, physical environment and the people’s characteristics and behaviour could also have an impact in one’s or the society’s health. Public health mentions the measures to avert diseases enhance health and lengthen the life span of individual and the public. It aims to deliver situations where the society can be in good health not just only the individual. Its concern is to deal with health threat of the community based on population based analysis. Therefore, PH is concerned with the health of the community as a whole and not just the individual.
An important document was published in 2003 by the WHO ‘The solid Facts’ on what determines health socially. This evidence pointed out the pivotal relationship between social and environmental factors that influences the health of an individual and the society and its implications. Wilkinson & Marmot, (2003) believe that the poor social-economic conditions of people can affect their health all their life. Those in the lower part of the ladder are usually unhealthy more than those in the upper class, and they are prone to die prematurely. Although, ill health affects the most times, the rich and those in the middle class also get affected unhealthily. Health is being affected by both psychological and material causes, they contribute differently, and their effects and causes to diseases thereby leading to death. Ill health has many disadvantages which could be absolute or relative and can lead to having little assets, poor educational background during adolescent, unsecured job or unemployment, unable to leave a stressful and no good paying job, poor housing condition, building a family in a difficult situation, and living in a retirement pension that is inadequate. These shortcomings focus on the same people in the poor social class and these affects their health as it accumulates in life. The more people stay in a demanding socio-economic situations the more they weaken physiologically, psychological and health wise which makes them not to enjoy their old age healthily.
The association between an individual and the public’s health is partly built on the dichotomy of medical and public health. Impending weaknesses of recent opinions includes seeing individual and the society’s health as a total and free concepts. It has been argued that the link between individual and the society’s health is basically comparative and dynamic. The relationship can be linked to the life course (Hogan et al, 2011) view on determinant of health where the conception of an individual via growth, development and involvement of his health till death. As known, surveillance and promotion of health is the main key to public health interventions. In addition, treatment is necessary in the outbreak of diseases, immunization, prevention and spread of diseases through health education is also important in the improvement of the health status of individual and the public (Arah, 2009). The main aim of PH is to enhance the status of the health of the public and the community by preventing and treating of diseases. PH tackles all areas of health which are known as a threat to the community which is established by a few people or in a pandemic country. Also, public health aims to prevent diseases and improve the health of the community by promotion of health programmes.
In this essay, I will argue that public health is not only for an individual but for the society with useful evidence from other literatures and authors. For example, an individual’s health cannot be perceived as being in an isolation, but must be viewed from either the socio-economic status or other social determinants such as their environment, class, etc. this also goes to the society where they are given the rights to instigate, shape, and take responsibility of promoting their health. In addition, an individual and the community are effective when they determine their health and are able to make the governments and private sectors responsible for any health policies and practices that are detrimental to them. The ‘how much’ and ‘what’ of an individual and the community’s health cannot be discussed until the increasing traits of both, by the use of causative factors. The community always leads in instigating, shaping and promoting health, the right means and prospects to enhance their assistance to be sustained. The undeveloped community needs support (Fraun, 2008). In the course of this essay, the aims, theories and public health policies will be discussed.
It was highlighted by the Ottawa Charter that the purpose for promoting health is to change further than what is basically person to passive method of getting health enhancement facts and techniques, to one where an individual is supported to develop into an active participant with better control over their health and well-being, thereby initiating bigger achievement on a group and societal level. Empowerment with social psychology creates self-efficacy and locus of control of health, discusses the methods of interaction between individuals and groups socially, aims to enable people to develop their personal and societal skills and the possibility and choice of directing their lives. (Erben, Franzkowiak & Wenzel, 2000) Empowerment can happen in individual and in the society. The centre of empowering people is principally connected with the bottom up method to promoting health (process of decision making originates at the individual or societal level, and their agreed are taken to the superiors for authorization and application) which gave attention to matters that concerns the society in particular or individual, and respects some enhancement in their general power or ability as the vital health result. (Laverack & Labonte, 2000)
While the rights of people have been interpreted in various ways, Anglo-Saxon advocates that the rights concerns both the individual and the society at large and this should be clear and it should be focused on the privileges of the community’s dignity and not side lined. This means that the rights of the people are bound to their values and unity and this should be empowered (Tajer, 2003; Solar and Irwin, 2006) A vital requirement for defining an individual’s and population health in terms of their setting is that the environment must be changing and contributing. When an individual is born, they grow from childhood, teenage hood, to adult life, making themselves accustomed to ways of life of the society, interact with other people, they fall sick, survive, marry, have their kids and become whom they mould themselves to be. This life course of health and well-being was recently discovered and interpreted by social epidemiologist, something that has been known to psychologists, sociologists, etc. for many years (Kuh and Ben-Shlomo 2004).
An individual’s wellbeing and the population’s health through all age group is influenced by some factors either within and outside in which they can or cannot control. Using the Dahlgren and Whitehead (1991) ‘policy rainbow’, it describes how the health of an individual and the society is being influenced by some factors. These factors are not modifiable such as the sex, age, personal lifestyle of an individual, the social and physical environment, and extensive socio economic status, cultural and environmental conditions (Dahlgren and Whitehead, 2007). This model was useful in given a framework on the contribution of each factor, the possibility of changing these factors and the corresponding actions that was required to effect these factors. It was also useful for researchers to create a variety of hypotheses about what determines health, explore those influences on those determinants and come out with different outcomes and interactions of these determinants (Shaw, 2004)
The collective action model is a socio-ecological approach that talks about the relationship between an individual and his environment. It is viewed that the health of an individual is being determined by some factors that is operated within and outside locus of control (Kawachi et al, 2004) of the individual. This model which also includes the community ensures that people acquire the necessary services, knowledge, experience, understanding and the zeal to enhance the structures of the society that can influence the health status of the society. It involves people to think critically in order to develop their understanding on the factors that affects the well-being of an individual and the society as a whole. It also involves the use of critical action that contributes positive change. The collective action model is important in determining health because it is expected to realize its health outcomes for the individual and the society. This is where The Ottawa Charter for Health Promotion (WHO, 1986) delivered most of its drive for change using this model for promoting health and health education. The Charter recognises that most of the health benefits were a little related to advance in medical knowledge which increases the living standard and public health initiatives which was followed by policy modifications at the government and community levels.
In practice, because the impact of social determinants on the health of the individual and the patients are being witnessed by the nurse, they provide care to and the wider society. They also recognise that the main causes of disease and bad behavioural lifestyles are dealt with; the NHS will frequently be mandated to deal with the outcome (RCN, 2012). In 2002, the community Approach to improving public health: community development for community nurses was published to identify the significance of team working with people to recognise and get solutions to problems affecting the community. This approach takes a wider look on health rather than the disease itself and has an assessment of social structures which underpins the health and well-being of the society. This approach empowers the people to take control of their lives and their health (RCN, 2002).
Health promotion at an individual level may thus not be effective for all individuals who come to the education or intervention with different experiences or backgrounds. Educational level may dictate the level to which people can understand health promotion campaigns or the medical reasons why they may need to alter their behaviour. Health education promotion may also be unable to interest everyone due to the different motivations for change that people may have - someone who is struggling to pay the mortgage bills to keep their house may have less motivation to ensure they are eating healthily to make sure they do not develop diabetes. These individual differences in regards to health may exert a potentially large detrimental effect on the efficacy of health promotion programmes when decision making in regards to targeted behaviour, resource allocation etc, have been made without consultation with those the intervention is designed for, as is the case in typically top-down programming approaches.
The behavioural change model which is widely used with other models is an approach that prevents and focuses on the lifestyles and behaviours that affect an individual’s health. It strives to motivate an individual to embrace a healthy lifestyle by making use of the preventive measures provided and taking responsibility of their health. This model believed that by giving people the right information, it will help to change their lifestyles, beliefs, behaviours and approaches to health. It was evidenced that this model is not effective because social environmental factors that affects health are being ignored (Nutbeam, 2000). It was argued by some writers that the top to down and bottom to up programs for promoting health is not necessary to function on a communal basis (Laverack & Labonte, 2000). They argue that the way these techniques can be integrated into the top to down programs is by aiming at the behavioural change. For instance, by being concerned with the society’s experience of empowerment in regards to the value of their relationships socially, and self-identification than focus on changing their specific health behaviours (Laverack & Labonte, 2000).
A community is a cluster of people that shares a common sense of social identity, customs, beliefs, morals, aims and bodies (Bergsma, 2004). The community enablement seeks to assist its people improve on their skills in order for them to be in a point to partake in making decisions within their broader society over matters that may affect their health and lives and take control over their personal, social, economic and political powers in order to take action to enhance their lives (Bergsma, 2004). Through interpersonal relationship, individual in a community may assess their behaviours of health and if need be, the authorities will be able to aim effective resources. In the society itself, teamwork will linger to enable the individual to allow community contribution to change to greater abilities in due time. Negatively, empowerment in the community level will initiates perspectives that are likely to be interpreted as a waste of time by those who previously participated, this may cause doubt in the community thereby hindering future health promotion initiatives.
In tackling health inequalities, The Wanless report-Securing good health for the population (DH 2004a) recognised that determinants of health and the prevention of disease is being complemented by investment of the economy and development of policy. Between 2004 and 2008, The NHS improvement plan (DH, 2004b) set some criteria for health with a goal for PH, with a 10year support plan for the NHS (DH, 2000). The NHS has a role to play in meeting the target, most especially in the element of life expectancy. This has been evidently incorporated into the Public Service Agreement health target, and using the discoveries of the Wanless report which noted the relationship between lower socio economic status and poor health outcomes and the effect of cost it has on the NHS (Wanless, 2004).
In 2001, a national health inequalities goal was fixed to provide the changing and increasing needs of health inequalities and its outcomes in infants’ mortality and life expectancy by 2010. Another strategy, the Programme for Action (DH, 2003) emphasises on the vital need of the government to work with individual and the society in order to strengthen the capacity to deal with wicked issues, prevents diseases, provides effective treatment and addresses the social determinants of health. A government policy in dealing with health inequality, Choosing Health: Making Healthier Choice easier (DH, 2004c) encourages individuals to take preventive measures to avoid ill health and improve community for all including the defenceless.
Fair Society, Healthy Lives (2010) sets out to tackle health inequalities and it’s the implications. It was made clear that circumstances such as the social environment, psychosocial, physical, behavioural and biological factors are all significant effects on health. In healthcare practice, in order for health inequalities to be tackled, the wider perspectives of people’s lives need to be considered by the PH leader. For example, assisting people into work which can be good for health provides income. Timely educational development of a child leads to an achievement that is vital for future health and wellbeing, and also improves job prospects and reduces poverty.
There are many theories that try to explain health inequality. Behavioural and cultural explanations suggest that individual behavioural choices are responsible for health outcome. The lower the income status, the person is more likely to engage in less health promoting form of behaviour. It is also found that those with more years of schooling, and with more qualification, are found to have healthier diets, to smoke less and do more exercise (Bartley 2004).
The psycho-social model argues that the health difference between people in more and less advantaged social positions cannot be explained purely by material factors (Marmot, 2005). Psychosocial model focus on how feeling that arises because of inequality, domination, or subordination may directly affect biological process by altering body chemistry. This model argues that availability of social support, control and autonomy at work, the balance between home and work, the balance between efforts and rewards etc. can affect health (Bartley 2004).
The materialist framework sees the objective living conditions people living in explain relation between poverty and health. Material condition of life associated with poverty lead to greater likelihood of physical problems, developmental problems, educational problems and social problems (Blane et al. 1998). Neo-materialist model explains the relationship between population health and income inequality. It looks beyond individual level and gives more attention to whole societies and how they differ. It is argued that absolute income is not the determinant rather its distribution is the matter (Wilkinson and Pickett 2009).
Basic premise of life course approach is that persons past social experiences affect the physiology and pathology of their body. So this model argues that health in later adult life may be a result of complex combinations of circumstances taking place over time and the cumulative effects of circumstances can affect the health negatively in future (Davy Smith et al. 2002). The major purpose of the life course researchers is to see whether the difference in health between people in different groups is due to past adverse life circumstances (Bartley 2004)
The social class, financial and educational status, behaviours, and other factors of the parents like the cognitive and psychological growth has shown evidently that it affects the health of the individual (Case et al. 2005). If circumstances could evidently mould the health and well-being and social life of an individual and the society in an increasing manner, why then must the health of the people is seen as an individual functioning as a normal cause? Neither the society’s nor the individual’s health can be seen in a cross sectional view (Norderfell, 2007). Throughout the individual’s life time, the he becomes the community, same goes to the society because if the determinants of health and inequalities affect an individual, it becomes the problem of the community either directly or indirectly. This individual in a society should not be taken usual custom of individuality that suggest trace of antagonism, but should be treated as a form of concern (Navarro, 2001). This concern is what is essential in life to construct an environment worthy of individualism, freedom and the health and well-being of the society.
In conclusion, everyone has their responsibility for their health and well-being. The society has a duty to enhance its people to live healthily in its environment and cultivate healthy lifestyles. Individual’s and the community’s health are not separable. It is believed that even if they are separated, the community approach is stronger in the context of health and its causes. It may be asked if the relationship between an unhealthy individual and the society could be understood to imply that they cannot be found the healthy individual’s environment.
Old-fashioned top to down promotion of health programs have been known to operate in a way that the minority are empowered over those which it aimed to help, through the control it used in respects to directing behaviours of health for change, allocation of resources, facts, and depending on healthcare practitioners to make decisions over the health of the individual. This is added for those who downgraded in society, who still have slight control over other parts of their living and working conditions, which have the potentials to affect the status of their health. Bottom to up tactics of promoting health started to re-address the stability of power, through empowerment approaches on both the at the individual and society level, in order to get people involved and able to make decisions about their health. Evidence has it that empowerment have several positive and negative implications on both the individual and the society at large, even though it is very encouraging to the society, and the will-power that an individuals have in making and taking informed decisions over their own health.
However, if the health information is not characterised at the individual or the society level, there is a slight understanding that is gained by saying that the community or an individual is healthy. Critically, the people’s and individual’s health includes all oriented well-being under health. The normativity school believes that health is refreshingly levelled to one’s well-being. Therefore, health is an integral part of well-being and one’s ability to value and control their lives and health, it is then not a surprise to know that the limitations of health can intrude the limitations of the people’s well-being and their lives as a whole. Health which is a representative of all functions meets the capabilities and achieves the vital aims of life.
REFERENCES
Arah, O. A. (2009). On the relationship between individual and population health. Med Health Care Philos.; 12(3): 235–244. Online: 2http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2698967/. December, 2014.
Bartley, M. (2004). Commentary: Relating social structure and health. International Journal of Epidemiology; 32:958–960
Bergsma, L (2004) Empowerment education. American Behavioural Scientist Vol.48, 2
Blane, D., Smith, G. D., and Bartley, M. (1998). Social class differences in years of potential life lost: size, trends, and principal causes. BMJ. 1; 301(6749):429-32.
Case, A., Fertig, A. and Paxson, C. (2005). The lasting impact of childhood health and circumstance. Journal of Health Economics 24: 365–389.
Commission on Social Determinants of Health (2008). A Conceptual Framework for Action on the Social Determinants of Health. Online: http://www.who.int/social_determinants/resources/csdh_framework_action_05_07.pdf. January, 2015
Dahlgren, G. & Whitehead, M. (1991). Policies and strategies to promote social equity in health. Institute for Future Studies, Stockholm (Mimeo).
Dahlgren, G. and Whitehead, M. (2007). European strategies for tackling social inequities in health: Levelling up Part 2. Copenhagen, WHO Regional Office for Europe (Studies on social and economic determinants of population health, No. 3).
Davey Smith, D., Dorling, R., and Mitchell, M. S (2002) Health inequalities in Britain: continuing increases up to the end of the 20th century. J Epidemiol Community Health: 56:434–435
Department of Health (2003) Tackling health inequalities.
A Programme for Action. Online: www.doh.gov.uk/healthinequalities/programmeforaction. Jan. 2015.
Department of Health (2004) Choosing Health: Making Healthier Choices Easier. Public Health White Paper. London: DH.
Erben, R., Franzkowiak, P. & Wenzel, E. (2000) People empowerment vs. social capital: From health promotion to social marketing. Health Promotion Journal of Australia: l.9, 3
Fassin, D (2000). Comment faire de la santé publique avec des mots. Une rhétorique à l’oeuvre. Rupture, revue transdisciplinaire en santé; 7:58-78.
Fraun, B. (2008). Planning and Evaluation of Community-based health promotion, (edn.). Oxford: The New Public Health, Oxford University press: 203-04.
Graham, H. (2004) Social determinants and their unequal distribution Milbank; 82(1):101-24.
Hills, M. & McQueen, D. V. (2007). At issue: Two decades of the Ottawa Charter. Promotion & Education; 14 (suppl 2):5.
Kawachi, D. K., Coutts, A. S., Subramanian, V. (2004). Commentary: reconciling the three accounts of social capital. Int. J. Epidemiol, 33: 682–690
Kickbusch, I. (2007). Health governance. The health society. In: McQueen, D. V., Kick-busch, I., Potvin, L. (Eds.), Health & Modernity: The Role of Theory in Health Promotion. New York, NY: Springer;
144-61.
Kuh, D. and Ben-Shlomo, Y. (2004). A Life Course Approach to Chronic Diseases Epidemiology. USA: Oxford Medical Publications; Oxford University Press, USA.
Lalonde, M. (1974). A New Perspective on the Health of Canadians. A Working Document. Ottawa: Ministry of Supply and Services Canada. Available at: www.hc-sc.gc.ca/hcs-sss/alt_formats/hpb-dgps/pdf/pubs/1974-lalonde/lalonde-eng.pdf. November, 2011.
Laverack, G & Labonte, R (2000) A planning framework for community empowerment goals within health promotion. Health Policy and Planning Vol.15, 3
Mann, J. (1996). Health as a human right. BMJ; 312: 924-25.
Marmot, M. (2005). Social determinants of health inequalities. Lancet, 365: 1099-104.
Marmot, M. (2010) Fair Society, Healthy Lives: Strategic Review of Health Inequalities in England post 2010. Available online: www.marmotreview.org. November, 2014.
Navarro V. Shi L. (2001). The Political context of Social Inequalities and Health International. Journal of Health Services: 3: 1-21.
Nordenfelt, L. (2007). The concepts of health and illness revisited. Medicine, Health Care and Philosophy 10: 5–10.
Nutbeam, D. (2000). Health Literacy as a Public Health Goal: A Challenge for Contemporary Health Education and Communication Strategies into the 21st Century. Health Promotion International: 15(3), 259–267.
Parrish, R. G. (2010). Measuring population health outcomes. Prev Chron Dis; 7(4):A71.
RCN, (2002). The community Approach to improving public health: community development for community nurses. Online: www. rcn.org.uk/data/assets/pdf file/0005/7851/001445.pdf. December, 2014.
Saan, H. (2007). Ottawa 1986 revisited. Promotion & Education; 14 (2):11.
Shaw, M. (2004). Housing and public health. Annu. Rev. Public Health, 25: 397–418
Solar, O., Irwin, A. (2006). Social determinants, political contexts and civil society action: a historical perspective on the Commission on Social Determinants of Health. Health Promot J Austr; 17(3):180-5.
Tajer, D. (2003). Latin American social medicine: roots, development during the 1990s, and current challenges. Am J Public Health; 93(12):1989-91.
Hogan, V. K., Rowley, D., Bennett, T. and Taylor, K. D. (2011). Life Course, Social Determinants, and Health Inequities: Toward a National Plan for Achieving Health Equity for African American Infants—a Concept Paper. Matern Child Health J. Online: http://prime.mihealth.org/files/2013-06-07/Hogan%20et%20al%20-%20life%20course%20social%20determinants%20and%20health%20inequities1.pdf. January, 2015.
Wanless, D. (2004). Securing Good Health for the Population, final report.
WHO (2002). Gender glossary. Appendix to Integrating gender perspectives in the work of WHO. WHO gender policy. Geneva.
WHO, (2003). The Solid Facts: Social Determinants of Health.
WHO (2005). The Bangkok Charter for Health Promotion in a globalised world.
WHO (1986). Ottawa Charter for Health Promotion: The move towards a new public health. An international conference on health promotion, Ottawa, Canada.
Wilkinson, R. G. & Marmot, M. (2003). (Eds). Social determinants of health: the solid facts. Copenhagen, WHO Regional Office for Europe.
Wilkinson, R. G., and Pickett, K. E. (2006). Income inequality and population health: a review and explanation of the evidence. Soc Sci Med.; 62(7):1768-84.
NAME: CHINAZOR NWOKOCHA
STD. ID: 3330731
WORD COUNT: 4077
The Ottawa Charter which was being approved by some researchers, makers of policies and practitioners came together in Canada to make a way for the countries in the WHO EURO region to pursue the Declaration of Alma Ata’s vision of “Health for All by the Year 2000” (WHO, 2011). 3 papers were cited as reminder for the Charter: the Lalonde report (1974), the Alma Ata Declaration and the optimistic meaning of health in preambles of WHO constitution (1946). The WHO constitution suggested an optimistic definition of health for the very first time as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (1946). However, …show more content…
it has been difficult to interpret this meaning of health into the society (Parrish, 2010), it still remains the most likeable and incorporative meaning of health. It creates the positive aspect of health (Kickbusch, 2007) other than the preventive adverse condition. It works as a summary to both the Alma Ata declaration and the Ottawa Charta and begins the statements that health is right of humans and the key elements that form health are societal (Mann, 1996).
2011 made it 25th year’s anniversary of Ottawa Charter for Health Promotion (WHO, 1986). Sometimes, it is presented as a document that promotes health (Hills & McQueen, 2007), but can be “tip of a much more complicated set of ideas and values” (Saan, 2007). Ottawa charter’s role was independently for public health to integrate health promotion widely. In the western world where it was developed, health promotion was known as the third revolution (Fassin, 2000), and a critical dialogue for public health. In recent times, health promotion has gone wide, not just for an individual alone but also for the community as a whole. This is supported by the Bangkok Charter which made the field of health promotion to be a global awareness by ensuring that there are commitment to be made by health professionals if they want they vision of health promotion in a community to be achieved (WHO, 2005). Therefore, the main worries of public health are to prevent diseases instead of the medicinal aspect of the disease. It deals at the population level other than at the individual levels.
The conditions in which people live have a profound influence on their health.
Difference in health between individuals and population groups exist in all societies. For example younger age population generally have good health compared to elder population. This kind of health difference cannot be concluded as health inequality because it is natural. So the question is that when the difference in health becomes inequality? According to Graham the difference in health between population groups becomes inequality when it is linked to the inequalities in their position in society (2007). World Health Organisation appointed Committee for the Social Determinates of Health (CSDH) also hold similar view as not all health inequalities are unjust or inequitable. If good health were simply unattainable, this would be unfortunate but not unjust. Where inequalities in health are avoidable, yet are not avoided, they are inequitable (2008). So the differences in health between groups having unequal position in society become an ethical …show more content…
issue.
The aims of promoting health are to optimistically enhance the behaviours of individual and the society on their health including those environmental and social factors that could affect their health negatively. Usually, the environment where a person lives is very vital for both the status of his health and quality of Life. It was recognized gradually that maintenance and improvement of health is not only via the progress and application of health science, but via healthy lifestyle choices made by an individual and the society as a whole. Although, the determinants of health according to WHO (2002) which could be economic and social environment, physical environment and the people’s characteristics and behaviour could also have an impact in one’s or the society’s health. Public health mentions the measures to avert diseases enhance health and lengthen the life span of individual and the public. It aims to deliver situations where the society can be in good health not just only the individual. Its concern is to deal with health threat of the community based on population based analysis. Therefore, PH is concerned with the health of the community as a whole and not just the individual.
An important document was published in 2003 by the WHO ‘The solid Facts’ on what determines health socially. This evidence pointed out the pivotal relationship between social and environmental factors that influences the health of an individual and the society and its implications. Wilkinson & Marmot, (2003) believe that the poor social-economic conditions of people can affect their health all their life. Those in the lower part of the ladder are usually unhealthy more than those in the upper class, and they are prone to die prematurely. Although, ill health affects the most times, the rich and those in the middle class also get affected unhealthily. Health is being affected by both psychological and material causes, they contribute differently, and their effects and causes to diseases thereby leading to death. Ill health has many disadvantages which could be absolute or relative and can lead to having little assets, poor educational background during adolescent, unsecured job or unemployment, unable to leave a stressful and no good paying job, poor housing condition, building a family in a difficult situation, and living in a retirement pension that is inadequate. These shortcomings focus on the same people in the poor social class and these affects their health as it accumulates in life. The more people stay in a demanding socio-economic situations the more they weaken physiologically, psychological and health wise which makes them not to enjoy their old age healthily.
The association between an individual and the public’s health is partly built on the dichotomy of medical and public health. Impending weaknesses of recent opinions includes seeing individual and the society’s health as a total and free concepts. It has been argued that the link between individual and the society’s health is basically comparative and dynamic. The relationship can be linked to the life course (Hogan et al, 2011) view on determinant of health where the conception of an individual via growth, development and involvement of his health till death. As known, surveillance and promotion of health is the main key to public health interventions. In addition, treatment is necessary in the outbreak of diseases, immunization, prevention and spread of diseases through health education is also important in the improvement of the health status of individual and the public (Arah, 2009). The main aim of PH is to enhance the status of the health of the public and the community by preventing and treating of diseases. PH tackles all areas of health which are known as a threat to the community which is established by a few people or in a pandemic country. Also, public health aims to prevent diseases and improve the health of the community by promotion of health programmes.
In this essay, I will argue that public health is not only for an individual but for the society with useful evidence from other literatures and authors. For example, an individual’s health cannot be perceived as being in an isolation, but must be viewed from either the socio-economic status or other social determinants such as their environment, class, etc. this also goes to the society where they are given the rights to instigate, shape, and take responsibility of promoting their health. In addition, an individual and the community are effective when they determine their health and are able to make the governments and private sectors responsible for any health policies and practices that are detrimental to them. The ‘how much’ and ‘what’ of an individual and the community’s health cannot be discussed until the increasing traits of both, by the use of causative factors. The community always leads in instigating, shaping and promoting health, the right means and prospects to enhance their assistance to be sustained. The undeveloped community needs support (Fraun, 2008). In the course of this essay, the aims, theories and public health policies will be discussed.
It was highlighted by the Ottawa Charter that the purpose for promoting health is to change further than what is basically person to passive method of getting health enhancement facts and techniques, to one where an individual is supported to develop into an active participant with better control over their health and well-being, thereby initiating bigger achievement on a group and societal level. Empowerment with social psychology creates self-efficacy and locus of control of health, discusses the methods of interaction between individuals and groups socially, aims to enable people to develop their personal and societal skills and the possibility and choice of directing their lives. (Erben, Franzkowiak & Wenzel, 2000) Empowerment can happen in individual and in the society. The centre of empowering people is principally connected with the bottom up method to promoting health (process of decision making originates at the individual or societal level, and their agreed are taken to the superiors for authorization and application) which gave attention to matters that concerns the society in particular or individual, and respects some enhancement in their general power or ability as the vital health result. (Laverack & Labonte, 2000)
While the rights of people have been interpreted in various ways, Anglo-Saxon advocates that the rights concerns both the individual and the society at large and this should be clear and it should be focused on the privileges of the community’s dignity and not side lined. This means that the rights of the people are bound to their values and unity and this should be empowered (Tajer, 2003; Solar and Irwin, 2006) A vital requirement for defining an individual’s and population health in terms of their setting is that the environment must be changing and contributing. When an individual is born, they grow from childhood, teenage hood, to adult life, making themselves accustomed to ways of life of the society, interact with other people, they fall sick, survive, marry, have their kids and become whom they mould themselves to be. This life course of health and well-being was recently discovered and interpreted by social epidemiologist, something that has been known to psychologists, sociologists, etc. for many years (Kuh and Ben-Shlomo 2004).
An individual’s wellbeing and the population’s health through all age group is influenced by some factors either within and outside in which they can or cannot control. Using the Dahlgren and Whitehead (1991) ‘policy rainbow’, it describes how the health of an individual and the society is being influenced by some factors. These factors are not modifiable such as the sex, age, personal lifestyle of an individual, the social and physical environment, and extensive socio economic status, cultural and environmental conditions (Dahlgren and Whitehead, 2007). This model was useful in given a framework on the contribution of each factor, the possibility of changing these factors and the corresponding actions that was required to effect these factors. It was also useful for researchers to create a variety of hypotheses about what determines health, explore those influences on those determinants and come out with different outcomes and interactions of these determinants (Shaw, 2004)
The collective action model is a socio-ecological approach that talks about the relationship between an individual and his environment. It is viewed that the health of an individual is being determined by some factors that is operated within and outside locus of control (Kawachi et al, 2004) of the individual. This model which also includes the community ensures that people acquire the necessary services, knowledge, experience, understanding and the zeal to enhance the structures of the society that can influence the health status of the society. It involves people to think critically in order to develop their understanding on the factors that affects the well-being of an individual and the society as a whole. It also involves the use of critical action that contributes positive change. The collective action model is important in determining health because it is expected to realize its health outcomes for the individual and the society. This is where The Ottawa Charter for Health Promotion (WHO, 1986) delivered most of its drive for change using this model for promoting health and health education. The Charter recognises that most of the health benefits were a little related to advance in medical knowledge which increases the living standard and public health initiatives which was followed by policy modifications at the government and community levels.
In practice, because the impact of social determinants on the health of the individual and the patients are being witnessed by the nurse, they provide care to and the wider society. They also recognise that the main causes of disease and bad behavioural lifestyles are dealt with; the NHS will frequently be mandated to deal with the outcome (RCN, 2012). In 2002, the community Approach to improving public health: community development for community nurses was published to identify the significance of team working with people to recognise and get solutions to problems affecting the community. This approach takes a wider look on health rather than the disease itself and has an assessment of social structures which underpins the health and well-being of the society. This approach empowers the people to take control of their lives and their health (RCN, 2002).
Health promotion at an individual level may thus not be effective for all individuals who come to the education or intervention with different experiences or backgrounds. Educational level may dictate the level to which people can understand health promotion campaigns or the medical reasons why they may need to alter their behaviour. Health education promotion may also be unable to interest everyone due to the different motivations for change that people may have - someone who is struggling to pay the mortgage bills to keep their house may have less motivation to ensure they are eating healthily to make sure they do not develop diabetes. These individual differences in regards to health may exert a potentially large detrimental effect on the efficacy of health promotion programmes when decision making in regards to targeted behaviour, resource allocation etc, have been made without consultation with those the intervention is designed for, as is the case in typically top-down programming approaches.
The behavioural change model which is widely used with other models is an approach that prevents and focuses on the lifestyles and behaviours that affect an individual’s health. It strives to motivate an individual to embrace a healthy lifestyle by making use of the preventive measures provided and taking responsibility of their health. This model believed that by giving people the right information, it will help to change their lifestyles, beliefs, behaviours and approaches to health. It was evidenced that this model is not effective because social environmental factors that affects health are being ignored (Nutbeam, 2000). It was argued by some writers that the top to down and bottom to up programs for promoting health is not necessary to function on a communal basis (Laverack & Labonte, 2000). They argue that the way these techniques can be integrated into the top to down programs is by aiming at the behavioural change. For instance, by being concerned with the society’s experience of empowerment in regards to the value of their relationships socially, and self-identification than focus on changing their specific health behaviours (Laverack & Labonte, 2000).
A community is a cluster of people that shares a common sense of social identity, customs, beliefs, morals, aims and bodies (Bergsma, 2004). The community enablement seeks to assist its people improve on their skills in order for them to be in a point to partake in making decisions within their broader society over matters that may affect their health and lives and take control over their personal, social, economic and political powers in order to take action to enhance their lives (Bergsma, 2004). Through interpersonal relationship, individual in a community may assess their behaviours of health and if need be, the authorities will be able to aim effective resources. In the society itself, teamwork will linger to enable the individual to allow community contribution to change to greater abilities in due time. Negatively, empowerment in the community level will initiates perspectives that are likely to be interpreted as a waste of time by those who previously participated, this may cause doubt in the community thereby hindering future health promotion initiatives.
In tackling health inequalities, The Wanless report-Securing good health for the population (DH 2004a) recognised that determinants of health and the prevention of disease is being complemented by investment of the economy and development of policy. Between 2004 and 2008, The NHS improvement plan (DH, 2004b) set some criteria for health with a goal for PH, with a 10year support plan for the NHS (DH, 2000). The NHS has a role to play in meeting the target, most especially in the element of life expectancy. This has been evidently incorporated into the Public Service Agreement health target, and using the discoveries of the Wanless report which noted the relationship between lower socio economic status and poor health outcomes and the effect of cost it has on the NHS (Wanless, 2004).
In 2001, a national health inequalities goal was fixed to provide the changing and increasing needs of health inequalities and its outcomes in infants’ mortality and life expectancy by 2010. Another strategy, the Programme for Action (DH, 2003) emphasises on the vital need of the government to work with individual and the society in order to strengthen the capacity to deal with wicked issues, prevents diseases, provides effective treatment and addresses the social determinants of health. A government policy in dealing with health inequality, Choosing Health: Making Healthier Choice easier (DH, 2004c) encourages individuals to take preventive measures to avoid ill health and improve community for all including the defenceless.
Fair Society, Healthy Lives (2010) sets out to tackle health inequalities and it’s the implications. It was made clear that circumstances such as the social environment, psychosocial, physical, behavioural and biological factors are all significant effects on health. In healthcare practice, in order for health inequalities to be tackled, the wider perspectives of people’s lives need to be considered by the PH leader. For example, assisting people into work which can be good for health provides income. Timely educational development of a child leads to an achievement that is vital for future health and wellbeing, and also improves job prospects and reduces poverty.
There are many theories that try to explain health inequality. Behavioural and cultural explanations suggest that individual behavioural choices are responsible for health outcome. The lower the income status, the person is more likely to engage in less health promoting form of behaviour. It is also found that those with more years of schooling, and with more qualification, are found to have healthier diets, to smoke less and do more exercise (Bartley 2004).
The psycho-social model argues that the health difference between people in more and less advantaged social positions cannot be explained purely by material factors (Marmot, 2005). Psychosocial model focus on how feeling that arises because of inequality, domination, or subordination may directly affect biological process by altering body chemistry. This model argues that availability of social support, control and autonomy at work, the balance between home and work, the balance between efforts and rewards etc. can affect health (Bartley 2004).
The materialist framework sees the objective living conditions people living in explain relation between poverty and health. Material condition of life associated with poverty lead to greater likelihood of physical problems, developmental problems, educational problems and social problems (Blane et al. 1998). Neo-materialist model explains the relationship between population health and income inequality. It looks beyond individual level and gives more attention to whole societies and how they differ. It is argued that absolute income is not the determinant rather its distribution is the matter (Wilkinson and Pickett 2009).
Basic premise of life course approach is that persons past social experiences affect the physiology and pathology of their body. So this model argues that health in later adult life may be a result of complex combinations of circumstances taking place over time and the cumulative effects of circumstances can affect the health negatively in future (Davy Smith et al. 2002). The major purpose of the life course researchers is to see whether the difference in health between people in different groups is due to past adverse life circumstances (Bartley 2004)
The social class, financial and educational status, behaviours, and other factors of the parents like the cognitive and psychological growth has shown evidently that it affects the health of the individual (Case et al. 2005). If circumstances could evidently mould the health and well-being and social life of an individual and the society in an increasing manner, why then must the health of the people is seen as an individual functioning as a normal cause? Neither the society’s nor the individual’s health can be seen in a cross sectional view (Norderfell, 2007). Throughout the individual’s life time, the he becomes the community, same goes to the society because if the determinants of health and inequalities affect an individual, it becomes the problem of the community either directly or indirectly. This individual in a society should not be taken usual custom of individuality that suggest trace of antagonism, but should be treated as a form of concern (Navarro, 2001). This concern is what is essential in life to construct an environment worthy of individualism, freedom and the health and well-being of the society.
In conclusion, everyone has their responsibility for their health and well-being. The society has a duty to enhance its people to live healthily in its environment and cultivate healthy lifestyles. Individual’s and the community’s health are not separable. It is believed that even if they are separated, the community approach is stronger in the context of health and its causes. It may be asked if the relationship between an unhealthy individual and the society could be understood to imply that they cannot be found the healthy individual’s environment.
Old-fashioned top to down promotion of health programs have been known to operate in a way that the minority are empowered over those which it aimed to help, through the control it used in respects to directing behaviours of health for change, allocation of resources, facts, and depending on healthcare practitioners to make decisions over the health of the individual. This is added for those who downgraded in society, who still have slight control over other parts of their living and working conditions, which have the potentials to affect the status of their health. Bottom to up tactics of promoting health started to re-address the stability of power, through empowerment approaches on both the at the individual and society level, in order to get people involved and able to make decisions about their health. Evidence has it that empowerment have several positive and negative implications on both the individual and the society at large, even though it is very encouraging to the society, and the will-power that an individuals have in making and taking informed decisions over their own health.
However, if the health information is not characterised at the individual or the society level, there is a slight understanding that is gained by saying that the community or an individual is healthy. Critically, the people’s and individual’s health includes all oriented well-being under health. The normativity school believes that health is refreshingly levelled to one’s well-being. Therefore, health is an integral part of well-being and one’s ability to value and control their lives and health, it is then not a surprise to know that the limitations of health can intrude the limitations of the people’s well-being and their lives as a whole. Health which is a representative of all functions meets the capabilities and achieves the vital aims of life.
REFERENCES
Arah, O. A. (2009). On the relationship between individual and population health. Med Health Care Philos.; 12(3): 235–244. Online: 2http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2698967/. December, 2014.
Bartley, M. (2004). Commentary: Relating social structure and health. International Journal of Epidemiology; 32:958–960
Bergsma, L (2004) Empowerment education. American Behavioural Scientist Vol.48, 2
Blane, D., Smith, G. D., and Bartley, M. (1998). Social class differences in years of potential life lost: size, trends, and principal causes. BMJ. 1; 301(6749):429-32.
Case, A., Fertig, A. and Paxson, C. (2005). The lasting impact of childhood health and circumstance. Journal of Health Economics 24: 365–389.
Commission on Social Determinants of Health (2008). A Conceptual Framework for Action on the Social Determinants of Health. Online: http://www.who.int/social_determinants/resources/csdh_framework_action_05_07.pdf. January, 2015
Dahlgren, G. & Whitehead, M. (1991). Policies and strategies to promote social equity in health. Institute for Future Studies, Stockholm (Mimeo).
Dahlgren, G. and Whitehead, M. (2007). European strategies for tackling social inequities in health: Levelling up Part 2. Copenhagen, WHO Regional Office for Europe (Studies on social and economic determinants of population health, No. 3).
Davey Smith, D., Dorling, R., and Mitchell, M. S (2002) Health inequalities in Britain: continuing increases up to the end of the 20th century. J Epidemiol Community Health: 56:434–435
Department of Health (2003) Tackling health inequalities.
A Programme for Action. Online: www.doh.gov.uk/healthinequalities/programmeforaction. Jan. 2015.
Department of Health (2004) Choosing Health: Making Healthier Choices Easier. Public Health White Paper. London: DH.
Erben, R., Franzkowiak, P. & Wenzel, E. (2000) People empowerment vs. social capital: From health promotion to social marketing. Health Promotion Journal of Australia: l.9, 3
Fassin, D (2000). Comment faire de la santé publique avec des mots. Une rhétorique à l’oeuvre. Rupture, revue transdisciplinaire en santé; 7:58-78.
Fraun, B. (2008). Planning and Evaluation of Community-based health promotion, (edn.). Oxford: The New Public Health, Oxford University press: 203-04.
Graham, H. (2004) Social determinants and their unequal distribution Milbank; 82(1):101-24.
Hills, M. & McQueen, D. V. (2007). At issue: Two decades of the Ottawa Charter. Promotion & Education; 14 (suppl 2):5.
Kawachi, D. K., Coutts, A. S., Subramanian, V. (2004). Commentary: reconciling the three accounts of social capital. Int. J. Epidemiol, 33: 682–690
Kickbusch, I. (2007). Health governance. The health society. In: McQueen, D. V., Kick-busch, I., Potvin, L. (Eds.), Health & Modernity: The Role of Theory in Health Promotion. New York, NY: Springer;
144-61.
Kuh, D. and Ben-Shlomo, Y. (2004). A Life Course Approach to Chronic Diseases Epidemiology. USA: Oxford Medical Publications; Oxford University Press, USA.
Lalonde, M. (1974). A New Perspective on the Health of Canadians. A Working Document. Ottawa: Ministry of Supply and Services Canada. Available at: www.hc-sc.gc.ca/hcs-sss/alt_formats/hpb-dgps/pdf/pubs/1974-lalonde/lalonde-eng.pdf. November, 2011.
Laverack, G & Labonte, R (2000) A planning framework for community empowerment goals within health promotion. Health Policy and Planning Vol.15, 3
Mann, J. (1996). Health as a human right. BMJ; 312: 924-25.
Marmot, M. (2005). Social determinants of health inequalities. Lancet, 365: 1099-104.
Marmot, M. (2010) Fair Society, Healthy Lives: Strategic Review of Health Inequalities in England post 2010. Available online: www.marmotreview.org. November, 2014.
Navarro V. Shi L. (2001). The Political context of Social Inequalities and Health International. Journal of Health Services: 3: 1-21.
Nordenfelt, L. (2007). The concepts of health and illness revisited. Medicine, Health Care and Philosophy 10: 5–10.
Nutbeam, D. (2000). Health Literacy as a Public Health Goal: A Challenge for Contemporary Health Education and Communication Strategies into the 21st Century. Health Promotion International: 15(3), 259–267.
Parrish, R. G. (2010). Measuring population health outcomes. Prev Chron Dis; 7(4):A71.
RCN, (2002). The community Approach to improving public health: community development for community nurses. Online: www. rcn.org.uk/data/assets/pdf file/0005/7851/001445.pdf. December, 2014.
Saan, H. (2007). Ottawa 1986 revisited. Promotion & Education; 14 (2):11.
Shaw, M. (2004). Housing and public health. Annu. Rev. Public Health, 25: 397–418
Solar, O., Irwin, A. (2006). Social determinants, political contexts and civil society action: a historical perspective on the Commission on Social Determinants of Health. Health Promot J Austr; 17(3):180-5.
Tajer, D. (2003). Latin American social medicine: roots, development during the 1990s, and current challenges. Am J Public Health; 93(12):1989-91.
Hogan, V. K., Rowley, D., Bennett, T. and Taylor, K. D. (2011). Life Course, Social Determinants, and Health Inequities: Toward a National Plan for Achieving Health Equity for African American Infants—a Concept Paper. Matern Child Health J. Online: http://prime.mihealth.org/files/2013-06-07/Hogan%20et%20al%20-%20life%20course%20social%20determinants%20and%20health%20inequities1.pdf. January, 2015.
Wanless, D. (2004). Securing Good Health for the Population, final report.
WHO (2002). Gender glossary. Appendix to Integrating gender perspectives in the work of WHO. WHO gender policy. Geneva.
WHO, (2003). The Solid Facts: Social Determinants of Health.
WHO (2005). The Bangkok Charter for Health Promotion in a globalised world.
WHO (1986). Ottawa Charter for Health Promotion: The move towards a new public health. An international conference on health promotion, Ottawa, Canada.
Wilkinson, R. G. & Marmot, M. (2003). (Eds). Social determinants of health: the solid facts. Copenhagen, WHO Regional Office for Europe.
Wilkinson, R. G., and Pickett, K. E. (2006). Income inequality and population health: a review and explanation of the evidence. Soc Sci Med.; 62(7):1768-84.