Appraisal of a Health Promotion Initiative - Essay Example

APPRAISING HEALTH PROMOTION PROJECT Introduction Public health is one of the most important concerns in any country. A healthy nation is a productive nation and it is the prerogative of the government to ensure working public health strategies. Public health is ensured through working health promotion strategies which are geared towards improving different aspect of personal health care. Health promotion programs are based on some defined principles that act the bases for planning and implementing a health promotion program. These principles provide the guideline and framework for implementation of such program. An effective health promotion program should comprise of direct actions on the determinants of the causes of health. They should also be in line with cultural practices of the targeted community since these can be a great impediment to implementation of the health promotion program. In order to understand the principles of a health promotion program, this paper will review Koori community directed health promotion program in Goulburn Valley. Summary of the chosen intervention Koori community directed health promotion program in Goulburn Valley was a health promotion program that was implemented in Northern Victoria, Australia. The program was community directed and funded by the state but also involved university researchers. This program was aimed at addressing the critical issues that have been raised in health approach in the region where the community had called for ending ‘the ambulance at the bottom of the cliff approach to health’ and hence put more emphases on cultural appropriate and community directed prevention strategies. This program was aimed at addressing the nutritional needs of the Koori community through improvement of their nutritional knowledge and participation in physical exercises. It was made up of three separate but closely related activities which were devised and implemented in the realm of Participatory Action Research framework. The program was made of different intervention strategies which were devised in close collaboration and partnership between the implementers and the Koori community members. Implementers included researchers from non Aboriginal University. Social culture determinants of health Individual health is as a result of different interacting factors. Individual health results from the interplay of different factors that must be at balance for optimal health. According to Bamblett and Lewis (2006, p. 46) this principle also applies to community health where the health state is determined by different factors like: a) Social factors including economic and cultural conditions b) Government health policies c) Community knowledge or life skills Social factors have a lot of influence on health status since they dictate the influence of the environment factors on individual health. Social determinants of health include the economic and other social conditions under which a given community lives and which influence their health states (Reilley 2005, p. 53). In public health, it is evident that major diseases are determined by different interacting exposures which increase individual risk for disease. For example public health disease like cholera, diabetes, and others results from the economic and other practices at community level. Traditional approach to community health presumed that community health policy was all about providing funding for medical services. Under this approach social determinant were only reviewed in academics but were not considered practical to community health care (Barwick 1992, p. 76). However, it later came to be known that medical care was responsible for prolonging survival and improving prognosis of a given disease but the health of the population was pegged on the social and economic conditions. Social and economic conditions affect the conditions that make people ill and hence increase the need for medical care. This implies that any primary health care intervention program should be aimed at addressing the social economic conditions that make people ill. This view is shared by Raphael (2008, P. 73) who argue that community health is influenced by social determinants of health which include the economic and social conditions. These conditions influence individual and community health and the jurisdiction of community health. They are the basic or primary determinants of whether an individual will stay health or will become ill. Raphael (2008, p. 75) further argues that social determinants also determine the extent to which individual have the resources to achieve personal health goals. This means that they determine whether individual have the resources to satisfy their needs and hence cope with the changes in the environment which is the main cause of most community diseases. For example Raphael (2008, p. 74) show that most diseases result from changes in the environment. Social factor are therefore important in determining the health of the individuals. According to World Health Organization, social determinants of health influence the personal well being (Seedhouse 1997, p. 173). Some of the social determinants of health identify by WHO include income and social status, social support networks, education and literacy, employment and working conditions, social environments, physical environments, life skill, coping skills, healthy child development, biological and genetic endowment, health services, gender, and culture (Reilley 2005, p. 128). However, further research into this filed have identified other factors including early life, education, food security, housing, social safety net, social exclusion, others. The initial concept in implementation of the Koori community directed health promotion program in Goulburn Valley was based on the need to address the imbalance in social determinants of health in the region. The baseline survey which was based on review of the previous studies had shown that although there were working government health care policies in the community, the local community had recorded increased case of cardiovascular incidences and obesity. The preliminary result of most studies had identified that the community was not eating fruits and vegetables or exercising the recommended levels hence the higher incidence of cardiovascular diseases and obesity. Research findings had also shown that determinant of health in the community were broader that the conventional risk factors that were pursued by the government health policies. This implied that there were other factors like history, community relationships, members’ connection to their land, cultural opportunity expression, community control and other factors (Reilly, 2005; Appo & Mohamed, 2002, p. 35). Therefore this project was aimed at taking a different community owned approach which was culturally aligned to promote change in community health behaviors with special focus on nutritional and physical exercises. In order to align with the need of the community to have a cultural aligned health promotion program, researchers ensured that community was given ownership of the project right from the strategy. Participatory Action Research (PAR) approach entails that researchers do not carry out their work in isolation but involves the members of the community in the research process (Baum and Smith 2006, p. 855). This approach ensures that the community takes ownership of the project and determines how it will be implemented in line with their social cultural dynamics. Researchers collaborated with the community in devising goals, objectives, methods, and also participated in the data analysis process. The main aim of the project was involving the community in order to promote changes in the lives of the participatory community group (Kidd and Kral, 2005, p. 190). PAR method is not a prescriptive method but it entails creating a context in which there is knowledge development and change among the members of the participatory. The project also tried to align to social and cultural issues by selecting a committee of senior community members and university representatives who together worked to oversee the designing and implementation of the project. The project comprised of the different strategies which were formulated after careful consideration of the previous research findings which exposed areas of concerns in community health. The intervention strategies were designed after a dialogues and consultative process to ensure that what was implemented was what the community wanted. One of the intervention strategies was Hungry for Victory which was a program involved 40 participants under the age of 17 years and 14 years and members of Rumbalar Football Netball Club. This was aimed at promoting health eating in sports and the program ran from April to August 2006 football season. The other strategy was Evaluation of the Nutritional and Physical Activity Guidelines Focus Groups which was aimed at creating specific nutritional guidelines to the community. It involved 27 members aged between 18 and 85 years who were selected from social networks. The other strategy was Cumeragunja Women’s Health and Wellbeing Group which focused on getting support from community members through social interactions. This project taught women nutritional and physical exercise tips to optimal health. The above strategy shows that this health promotion program identified with social determinants in different ways. Although it may have missed some like economic empowerment of the community, it focused on improving personal skills which are more important than economic empowers since individuals may have resources but fail to utilize them (Bamblett and Lewis 2006, p. 86). For example studies have shown that due to lack of skills members of rural community sometimes sell nutritious foods like eggs to buy fad foods like chips. This project was therefore in line with social and culture needs of the community in different aspects. How the project aligned with principles of health promotion Health promotion concepts mainly entailed empowering people to have control over and to improve their health status. Health promotion is a positive concept that puts more emphasis on personal, social, political, and institutional resources including individual capacities to improve their health (Mackenbach and Baker 2002, p. 97). Health promotion concepts combines health, education, economic, political, spiritual and organizational initiatives with an aim of bringing about positive change to the community especially change in behavior, social environment, and others which can improve the health of the population (Seedhouse 1997, p. 173). There are five main principles of health promotion that actually comprise the best practices while implementing a health promotion program. In order to evaluate whether Koori community health promotion adhered to the best practices, it is first important to understand the main principles that define best practices. The following are the five principles of a health promotion program (Taylor et al., 1982, p. 28): a) Health promotion must involve the population as a whole in such a way that it taps into their daily life rather than focusing on the group at risk from the targeted disease condition. b) Health promotion program must be directed towards action on the main determinant or the causes of health. This means that the health promotion program must be focused on different factors that influence individual health c) Health promotion must use different approach and complementary methods including communication, legislation, fiscal measures, community change, and many others which help improve the community health. d) It aims at public participation to be effective. The means that public must be involved in the designing of the program and promotion participation of the community members through working participation mechanism e) Health promotions should be understood and as a societal and political venture and not a medical services. Although it may include medical service, the main aim should be to promote the societal ability to prevent and cope with diseases. These are the five important principles that define a working health promotion programs. There are important areas that any health promotion program should emphasize on including building a health public policy, creating supporting environment, strengthening community action, developing personal skills, and finally re-orienting health services. These emphases are derived from the principles of a health promotion program and influence the effectiveness of the program (Taylor et al., 1982, p. 84). Koori community health promotion program aligned with the principles of health promotion program and focused on most of the above mentioned areas. First the program did not target a particular group of individuals at risk but it had three strategies that targeted different segment of the population. It has a strategy focusing on under 17 players in view of sports nutrition, one focusing on evaluation of community nutritional guidelines that targeted individuals from 18-85 years, and the other targeting women. This means that the programs had a broader approach and targeted all segments of the community. Second Koori community program employed different means in order to reach more people in the community. It did not rely on one method but rather combined different methods through PAR approach (Baum and Smith 2006, p. 854). It engaged young players through teaching them the importance of nutrition, held discussion with focused groups, and taught women the importance of nutrition through social interactions. Third, Koori community program mainly targeted the community for implementation of the program. Right from the start, the program was aimed at coming up with a different approach to improvement of individual health rather than the method used by the government which did not involved the local community. This program was based on mutual agreement by the community and university researchers and the local community set the goals, objectives, and senior community members were involved in the management of the program. This was one of the best practices that are required for any health promotion program since it involves the community. Although the baseline studies had shown that the community was affected by different problems including cardiovascular and obesity problems, this program did not focus on providing medical services for those problems but it went into details of addressing the problem from the community health perspectives. A health promotion program should not take a medical approach to address a problem but rather take primary preventative measures that will benefit the while community. However the program did not deeply address the main problem contributing to the health problem since it addressed only one side. Although it is evident that economic issues may play a role in the problems facing the community, the program only worked to improve the community skills on nutrition and physical exercise. The current best practices as has been addressed in evaluation of this program provide an insight into the factors that may facilitate the success of the program. They are important since they help in appraising the different component of a health promotion program (Downie et al., 1996, p. 50). However, they fail in addressing issues of the effectiveness of the program in that they don’t provide for evaluation mechanism of the achievement of the aim of the project and objectives of its different components. Conclusion Health promotion programs are programs that are aimed at addressing a given community health problem from the point of social determinants. A health promotion program is aimed at addressing the main causative factors of the health problem rather than taking a medical approach which relieve symptoms but don’t address the root cause. Koori community project address the nutrition and physical activity problem by focusing on participatory approach that involved the community. The project adhered to a number of best practices but failed to provide different measures to combat the problem. However the program made good contribution to the community health initiatives. Bibliography: Appo, A. & Mohamed, J 2002, Ending ‘ambulance at the bottom of the cliff’ approach to health: An indigenous approach in the Goulburn Valley. World Rural Health International Conference, Melbourne Bamblett, M. & Lewis, P 2006, Creating a culturally competent service system for prevention and early intervention, SNAICC Perspective, Victoria Barwick, D 1992, Opportunity and Response, Hurst C, London Baum, R. & Smith, D 2006, Participatory Action Research, Journal of Epidemiology and Community Health, Vol. 60, pp854-857 Downie, R., Tannahill, C., & Tannahill, A 1996, Health promotion: Models and values, Oxford University Press, New York Kidd, S. & Kral, M 2005, Practicing Participatory Action Research, Journal of Counseling Psychology, Vol. 52, Issue 2, pp187-195 Mackenbach, J. & Baker, M 2002, Reducing inequalities in Health, Routledge, London Raphael, D 2009, Social determinants of Health: Canadian Perspectives, Canadian Scholars Press, Toronto Reilley, R 2005, Identifying psychosocial determinants of indigenous health, University of Melbourne, Melbourne Seedhouse, D 1997, Health promotion: philosophy, practice and prejudice, Wiley, New York Taylor, R., Ureda, J., & Dehnam, J 1982, Health promotion: Principles and clinical applications, Appleton-Century-Crofts, Norwalk Read More