Course:KIN366/ConceptLibrary/HealthPromotion

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Movement Experiences for Children
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KIN 366
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Instructor: Dr. Shannon S.D. Bredin
Email: shannon.bredin@ubc.ca
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Overview

Health Promotion has become more prevalent in recent years due to the increased occurance of deaths due to chronic disease that could have been averted through the adoption of healthier lifestyles. As a result of its greater use, the term has become associated with many broad definitions that refer to various facets of health, community and lifestyle modifications. The World Health Organization (2009, pg. 1) has defined the term as a “process enabling people to increase control over, and to improve their health.” The term has further progressed to create a common linkage between the encouragement of positive healthy behaviors and the prevention of disease with the addition of legal and fiscal measures created to advance health (Tannahill, 1985). Overall, the health promotion process can be built upon three main goals: to create healthy lives for more citizens, to eliminate health-care disparities among all ethnic and racial groups and to create access to prevention services for everyone (Polan and Taylor, 2007).

Definition of Health

Health is a dynamic concept and is difficult to define in a meaningful way due to endless research and innovative discoveries surrounding new illness and disease prevention. The older medical-biological perspective addresses health as the state of being free from chronic disease or disability (Koelen and van den Ban, 2004). However, this viewpoint is opposed by the belief that an individual’s subjective opinion of their health is a better descriptor of wellbeing, concluding that health is both objective and subjective (Koelen and van den Ban, 2004). Finally, in 1948, the World Health Organization defined health in relation to mental, social and physical wellbeing, incorporating the effects of interaction between the body and mind (WHO, 2009).

Physical Health

Physical health and physical fitness are related to health status through measures such as cardiovascular fitness, musculoskeletal fitness, body composition and stability (Warburton, 2013). Overall, if these variables are recognized to be in acceptable ranges, the individual is seen to be in good health. Physical fitness on the other hand can be related to the functionality of these variables and is measured by ones ability to complete activities of daily living independently (Warburton, 2013).

Mental Health

The discussion surrounding the mental component of health has been affected by the myths and fears that are unfittingly associated with the topic of mental illness (Cattan et al., 2006). In order to remove the large-scale idea of mental health from the negative stigmas of mental illness, there has been discussion to increase the use of terms with a more positive connotation such as mental well-being or emotional intelligence (Cattan et al., 2006). Overall, mental health is a dynamic, ecological aspect of health that is subjective to the methods an individual uses to cope and the way they perceive their environment, and is affected by their culture, physical health and social health (Cattan et al., 2006).

Social Health

The final component of holistic health can be defined with regards to a person’s ability to function adequately as a member of the community and create meaningful relationships with others (Donald et al., 1978). The importance of social health is evident in findings that demonstrate the reduction of harmful individual behaviors, such as suicide, in communities characterized by social integration and active participation by people in social activities (Donald et al., 1978).

History

The first international conference on Health Promotion was on November 21st, 1986 in Ottawa, Ontario and was primarily a response to the growing expectations of a new public health movement, mainly focusing on the needs of those in industrialized countries (WHO, 2015). The conference concluded that improvements in health would be based on a foundation of three prerequisites: to advocate, enable and mediate. The goal of advocating for health is to make various aspects of one’s life, such as social, cultural, environmental, behavioral and biological factors, more favorable than harmful, thereby increasing the quality of life (WHO, 2015). To enable means to increase equity in health by ensuring equal access to opportunities and resources allowing people to reach their full potential (WHO, 2015). And finally, mediation of the health promotion strategies must be completed through coordination of governments, social and economic sectors, voluntary organizations and the media (WHO, 2015). The second international conference built upon the adoption of the Declaration of Alma-Ata, which emphasizes people’s involvement and cooperation between sectors of society as its foundation. The charter identifies five health promotion areas: healthy public policies, creation of supportive environments, development of personal skills, strengthen community actions and reorient health services (WHO, 2015). The following conferences numbered 3 through 7 have focused on topics such as supportive environment, bridging the equity gap and review of previous strategies. These global scale health promotion conferences have slowly begun to show their effects at a national and community level through local promotional campaigns and governmental organizations.

Promoting and Maintaining Health

The main goal of health promotion is to increase awareness of healthy behaviors in order to allow individuals to reach their optimal level of wellness. Health promotion can occur at any time and it aims to target individual lifestyles and personal choices to allow full functional capacity at each stage in the lifespan. Essential components of health promotion are the spreading of knowledge, which occurs most successfully in a community, workplace or family that has a supportive social environment and overcoming issues though empowerment and giving individuals the feeling of social responsibility (Polan and Taylor, 2007).

Models of Health Promotion

Ecological Model

The Ecological Model for Health Promotion focuses on both individual and social environmental factors as targets successful health interventions (McLeroy et al. 1988). Importance of the interventions is mainly directed at changing interpersonal, organizational, community, and public policy; which are all factors that support and maintain unhealthy behaviors (McLeroy et al. 1988). This model assumes that changes in one’s social environment will produce changes in the individual, and further, the support of individuals in the community and family is essential for implementing the environmental changes (McLeroy et al. 1988).

Transtheoretical Model

The transtheoretical model suggests that a change in health behavior involves progress through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination (Prochaska and Velicer, 1997). Further, research found that if an individual is provided information from a health promotion program during the preparation and action phase there is an increased chance of health behavior change due to the higher level motivation, decisional balance and self-efficacy (Prochaska and Velicer, 1997).

Issues Targeted in Health Promotion

Nutrition

Evidence has shown that poor dietary habits have been associated with the five leading causes of death, which are coronary heart disease, cancer, stroke, diabetes and coronary artery disease (Polan and Taylor, 2007). Additionally, malnutrition is a poor dietary practice that results in the lack of essential nutrients being distributed throughout the body, which can heavily affect individuals, especially during critical periods of growth in the lifespan (Polan and Taylor, 2007). Overall, proper diet should supply an individual with an adequate amount of energy and incorporate foods from all food groups (Polan and Taylor, 2007). Dietary habits should also be subjective to the individual’s stage of life, health and daily energy expenditures (Polan and Taylor, 2007).

Exercise

Regular exercise has the ability to improve muscle strength and endurance, increase lung capacity, decrease tension and stress and maintain cardiovascular functioning (Polan and Taylor, 2007). Promotional strategies surrounding exercise requirements for health have however shifted from the idea of promoting exercise towards an increase in promotion of physical activity (Warburton, 2013). Although it is universally agreed upon that regular exercise does increase one’s overall fitness, exercise can be a foreign topic to many and thus avoided due to fear of injury or lack of knowledge on proper exercise techniques (Warburton, 2013). To eliminate this divide, more people are being encouraged to simply increase the amount of physical activity they do each day; these activities can range from household chores to a brisk walk (Warburton, 2013). This approach aims to eliminate barriers and promote health in a more manageable way for the general population. Overall, lifestyle changes with regards to exercise need to be subjective to the individual’s goals, interests and must presented in a manner that does not overwhelm the participant.

Substance Abuse

Substance abuse refers to the overuse of items such as alcohol, drugs, nicotine and caffeine (Polan and Taylor, 2007). This issue has not only been seen to affect an individual physically and mentally, but there are also signs of a lack of social awareness, a decline in self-esteem and a withdrawal from involvement (Polan and Taylor, 2007). Additionally, long term alcohol and tobacco use has been linked to conditions such as lung cancer, heart disease, fetal abnormalities and liver disease (Polan and Taylor, 2007). Health promotion therefore aims to increase awareness of the negative impact and decrease abuse of various harmful substances.

Important Areas of Health Promotion from Birth to Adolescence

Prenatal

Health promotion during this stage primarily focuses on health maintenance for the pregnant mother and teaching strategies that can be applied for future childcare (Edelman and Mandle, 1994). In order to create an optimal physical environment for the developing fetus, primary interventions should take place prior to pregnancy in the form of health classes (Edelman and Mandle, 1994). Secondary intervention may occur during pregnancy through monitoring of iron levels, assessment of nutrient intake, evaluating a healthy pattern of weight gain and engaging in routine physical activity (Edelman and Mandle, 1994). Weight gain that is required during pregnancy can often have a negative impact on female self-perception and create body image issues that can affect mental well-being (Polan and Taylor, 2007). In response to this issue, a greater emphasis should be placed on promoting coping strategies, as the maintenance of anxiety and mental stress will in turn assist in the healthy growth and development of the fetus.

Infancy (Birth to 12 months)

Health promotion during infancy aims to optimally develop primitive motor skills and psychosocial growth. Since the infant does not have control over his or her actions, the health promotion strategies are widely advertised to caregivers and families (Polan and Taylor, 2007). During childcare classes, parent should be taught that infants require open environments where they can gradually build strength in their major limbs and develop motor control (Edelman and Mandle, 1994). Although, all infants develop at their own pace, there are general guidelines that should be met in this stage of life. For example, at 2 month the infant should develop control of the head and progress to walking by 12-15 months. Since infants are largely experimenting with motor movements and bodily sensations in this stage it is the parent’s responsibility to provide ample opportunities of sensorimotor play and facilitate development (Gunner et al., 2005). Additionally, early assessment should be provided to the new born in order to allow early diagnosis or treatment for any abnormalities. Immunizations and regular check-ins with a physician play a large role in disease prevention (Edelman and Mandle, 1994). Cognitive development for the infant is facilitated by observation and sensory interaction with their environment (Polan and Taylor, 2007). Again, this is developed through increased interaction with the infant involving sensorimotor play and introduction to new environments and objects. During this stage of life, it is imperative for the infant to develop trust and a feeling of security (Polan and Taylor, 2007). Prompt and consistent response to the infant’s needs help foster security. Predictability and organized routines have been shown to decrease fear and anger in infants thereby increasing feelings of trust (Edelman and Mandle, 1994). Therefore, a stable caregiver-infant relationship pattern will allow for optimal social health during this period of time.

Toddler (1-3 years)

Gross and fine motor skills continue to develop through individual unstructured play and also the addition of structured play activities. It is recommended that toddlers accumulate at least 30 minutes daily of structured physical activity and 60 minutes of daily, unstructured physical activity (Gunner et al., 2005). Children in this age group should not be sedentary for more than 60 minutes at a time except when sleeping (Gunner et al., 2005). The aim of physical activity for growing toddlers is to develop skills that are building blocks for more complex movement tasks. During this stage toddlers are also trying to master independence in activities of daily living such as toileting, dressing and feeding. It is crucial to encourage children to make simple decisions ensuring they do not choose an unsafe option (Edelman and Mandle, 1994). The adult must handle any conflicts that occur, regarding mishaps the child makes, in a controlled manner in order to avoid damaging the toddler’s self-esteem (Edelman and Mandle, 1994). Furthermore, it should be noted that toddlers are naturally egocentric, that is they cannot perceive the world from any one else’s point of view; this can cause harmful behavior between a toddler and another child (Edelman and Mandle, 1994). In order to prevent hurting another child’s feelings it is essential that caregivers find techniques to explain that this behavior is offensive to promote healthy social relationships.

Preschool (3-5 years)

At this age, preschoolers are occupied with learning skills to master not only their physical world, but also their own behavior. Preschoolers should accumulate at least 60 minutes of daily structured physical activity and engage in at least 60 minutes and up to several hours of unstructured activity daily (Gunner et al., 2005). Also, it is crucial to attend yearly preventative health care check ups and get necessary booster shots to prevent illnesses such as tetanus and polio (Polan and Taylor, 2007). Finally, due to the increased interaction between children at this age, it is important to teach the child the importance of proper hygiene in order to reduce the likelihood of spreading simple infections such as the common cold. Parents and teachers should give advice on proper hand washing, covering the nose when sneezing or coughing and the use of tissues (Polan and Taylor, 2007).

School-Age (6-11 years)

At this stage children have developed enough proficiency in their motor skills and thus there is a resulting marked growth in muscle mass and muscle strength with increases in activity levels (Edelman and Mandle, 1994). By this age, children can actively participate in team sports, as they can better understand complex rules of games. With greater interaction outside the family group, peer groups naturally become a new and supportive social system therefore children may have to learn to conform to the standards of that group (Edelman and Mandle, 1994). It is vital for optimal mental and social health, that children are able to cope with tensions between peers and the stress of meeting standards of their peer group (Edelman and Mandle, 1994). With increased separation from parents during this period, children also start to make their own choices surrounding diet; school lunch programs can assist in guiding children towards understanding the type of nutrition required for their health, which improves the chances of the child meeting his or her daily requirements (Polan and Taylor, 2007).

Adolescent (11-14 years)

During this period of life health education regarding puberty is vital as the body is going through many hormonal and physical changes (Polan and Taylor, 2007). As a result, body image and appearance become of utmost importance in these years. This can become harmful especially if adolescents are influenced by unhealthy and unattainable images. Empowerment and emphasis on healthy lifestyle, possibly through sport, can influence the reduction of negative self-outlook (Edelman and Mandle, 1994). Sports, especially through adolescent years, provide a means for social and personality development; they provide physical activity, experience in competition, team effort, mature conflict resolution and self-esteem (Edelman and Mandle, 1994). Sex education is also important during these years as peer pressure to date or be sexually active increases (Polan and Taylor, 2007). Additionally, the rise in peer pressure can influence adolescent substance abuse, even though this behavior is illegal at this age (Polan and Taylor, 2007). Anti smoking and drinking campaigns have been implemented nationally, however it is universally understood that children this age will be tempted to experiment, therefore caregiver influence is vital to ensure safety and prevention (Polan and Taylor, 2007).

Examples of Canadian Health Promotion Strategies

ParticipACTION

Goal and vision is to increase physical activity for all Canadians and make activity a vital part of every day (ParticipACTION, 2013). Target families and individuals across the lifespan through the use of strategic advertising campaigns, programs and resources.

Do Bugs Need Drugs?

A community education program designed to teach young children about the importance of correct hand washing and responsible use for antibiotics (Do Bugs Need Drugs?, 2015). The aim is to prevent infections and maintain effectiveness of antibiotics through limiting their use.

BC School Fruit and Vegetable Nutritional Program

Aim of this project is to target school-age children and educate them on healthy nutritional habits by bringing local fruits and vegetables to schools for children to snack on (SFVNP BC, 2013). Goals are to increase the acceptability of, exposure to, and willingness to try fruits and vegetables and increase awareness of local fruits and vegetables (SFVNP BC, 2013).

Back to Sleep

Goal is to increase awareness and provide information of how to reduce of the chances of Sudden Infant Death Syndrome (SIDS) (Kassirer, 2012). Campaign targeted new parents through mass media messaging on habits such as the back sleeping position, second hand smoke and over-bundling the baby (Kassirer, 2012).

Barriers

Barriers to promoting health can be internal, meaning within the organization, or external, which is the response of the population to the information. Internal barriers include leadership and staffing, financial resources and decision-making processes (Robinson et al., 2006). External barriers are varied cultural perceptions of health, socioeconomic status, level of health literacy, accessibility to health care aids, time constraints and fear of health intervention (Robinson et al., 2006).

References

Cattan, M., & Tilford, S. (2006). Mental health promotion: A lifespan approach. Maidenhead, England: Open University Press.

Do Bugs Need Drugs?. (2015). About the program. Retrieved from http://www.dobugsneeddrugs.org/about/

Donald, C.A., Ware, J.E., Brook, R.H., & Davies-Avery, A. (1978). Conceptualization and measurement of health for adults in the health insurance study. Santa Monica, CA: Rand.

Edelman, C.L., & Mandle, C.L (1994). Health promotion throughout the lifespan. St. Louis, MO: Mosby-Year Book Inc.

Gunner, K.B., Atkinson, P.M., Nichols, J., & Eissa, M.A. (2005). Health promotion strategies to encourage physical activity in infants, toddlers and preschoolers. Journal of Pediatric Health Care, 19, 253-258.

Kassirer, J. (2004). Back to sleep – Health Canada SIDS social marketing campaign. Retrieved from http://www.toolsofchange.com/en/case-studies/detail/161/

Koelen, M.A., & van den Ban, A.W. (2004). Health education and health promotion. Wageningen, The Netherlands: Wageningen Academic Publishers.

McLeroy, K.R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15, 351-377.

ParticipACTION. (2013). Our vision. Retrieved from http://www.participaction.com/about/our-vision/

Polan, E.U., & Taylor, D.R. (2007). Journey across the life span: Human development and health promotion. Philadelphia, PA: F.A. Davis Company.

Prochaska, J.O., & Velicer, W.F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12, 38-48.

Robinson, K.L., Driedger, M.S., Elliot, S.J., & Eyles J. (2006). Understanding facilitators of and barriers to health promotion practice. Health Promotion Practice, 7, 467-476.

SFVNP BC. (2013). The story. Retrieved from http://sfvnp.ca/the-story.php

Tannahill, A. (1985). What is health promotion?. Health Education Journal, 44, 167-168.

Warburton, D.E.R. (Eds). (2013). Health-related exercise prescription for the qualified exercise professional. Vancouver, BC: Health & Fitness Society of BC.

World Health Organization. (2009). Milestones in health promotion: Statements from global conferences. Retrieved from http://www.who.int/healthpromotion/Milestones_Health_Promotion_05022010.pdf?ua=1

World Health Organization. (2015). Global conferences on health promotion. Retrieved from http://www.who.int/healthpromotion/conferences/en/