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Chapter: Medicine Study Notes : Public Health

Health Promotion

Health promotion is the “process of enabling people to increase control over, and to improve, their health” (Ottawa Charter).

Health Promotion


·        Health promotion is the “process of enabling people to increase control over, and to improve, their health” (Ottawa Charter)

·        Ottawa Charter had 5 strategies:

o  Build healthy public policy

o  Create supportive environments

o   Strengthen community action

o   Develop personal skills

o   Reorient health services 

·        The Treaty Understanding of Hauora in Aotearoa NZ (TUHANZ) is a framework adapting this to NZ (issued by the NZ Health Promotion Forum): 

o   Goal for Article 1 (kawanatanga/Governance): achieve meaningful Maori involvement in all aspects of health promotion 

o   Goal for Article 2 (Tino rangatiratanga/Maori control and self-determination): actively support the advancement of Maori health aspirations 

o   Goal for Article 3 (Oritenga/Equity): Prioritise health promotion action that improves Maori health outcomes 

·        Progress has been made on: Heart disease, SIDS, Road traffic accidents, cervical cancer 

·        Issues of concern: Maori to non-Maori gap, melanoma, youth suicide, obesity, ­STDs 

·        Compared to other OECD countries, NZ has high mortality from ischaemic heart disease, respiratory diseases, breast and bowel cancers, MVA, suicide

·        Role of health care sector:

o   See patients as part of a community, not just as individuals

o   Integrate with programmes delivered by others 

o   Move to a focus on the determinants of health (including socio-economic status – income and housing – culture, health care system, in addition to genetics, etc)

·        Strategies in the health care sector:

o   Care and support 

o   Screening: eg alcohol in pregnancy, cervical, six week check, opportunistic screening for diabetes, breast screening

o   Immunisation: childhood and influenza 

o   Health education: eg antenatal education including sun protection, diabetes, HIV, nutrition, exercise, smoking

o   Helping to build healthy public policy

o   Creating healthy institutions (eg Healthy Hospitals – integrating health promotion into their work)

·        Barriers:

o   Insufficient time with patients

o   Perceived or real cost disincentives

o   Uncertainty among providers about the evidence


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