EFFECT OF HEALTH PROMOTION IN TACKLING THE HEALTH OF BRITAIN AND THE RELATED ETHICAL IMPLICATIONS.

Health promotion is a socially embodied "value field"; its mission is to promote a Sanitary culture, one that locates health at the top of a hierarchy of cultural values and social goals. It is concerned with the whole person, the relationships between individuals and their environments and the wider forces that shape health. However, this essay is going to focus health promotion on coronary heart disease .In this context, the role of health promotion is in the primary prevention of cardiovascular diseases like coronary heart disease.

Heart disease comes in many different forms. The most common type of heart disease in Britain and in other Western countries is coronary heart disease (CHD). Coronary heart disease (CHD) also known as ischaemic heart disease, is the UK's biggest killer, causing around 82,000 deaths each year. About one in five men and one in eight women die from the disease. There are an estimated number of 2.7million people living with the condition and 2million people affected by angina, the most common symptom of coronary heart disease. In 1989, 92,480 men and 76,421 women died from coronary heart disease, an average of 460 people (the coronary prevention group, 1991).
Coronary heart disease (CHD) is usually caused by a build-up of fatty deposits on the walls of the arteries around the heart (coronary arteries). The fatty deposits, called atheroma, are made up of cholesterol and other waste substances. The build-up of atheroma on the walls of the coronary arteries makes the arteries narrower and restricts the flow of blood to the heart. This process is called atherosclerosis. The risk of developing atherosclerosis is significantly increased if the individual has a high blood pressure, high blood cholesterol level, lack of regular exercise, diabetes and smoking. As well as angina (chest pain), the main symptoms of CHD are heart attacks and heart failure. Health promotion, however, is an inherently value-laden enterprise and one that can lead to major ethical dilemmas.
There are five approaches to health promotion. Within this essay, the various approaches to health promotion will be analysed and explained in the form of medical, societal change, and behaviour change approach. As a result of the various approaches to health promotion, many health professionals are involved which include teachers, doctors, dieticians, pharmacists, clinicians, practice nurses and doctors, and government. Their role in health promotion will be discussed in the main body of the essay.
The medical approach involves medical intervention like immunization and screening to prevent or ameliorate ill-health, possibly using a persuasive or paternalistic method. The aim of this approach is freedom from medically defined disease and disability, such as infectious diseases, cancer and heart disease, and to reduce morbidity and premature mortality. It is based on scientific method.
The evidence of the effects of medical treatment in coronary heart disease is consistent and strong. Medical treatments for lowering high blood pressure and blood cholesterol are considered in this section because they show estimates of the scale of effect that might be achieved by maximum coverage and compliance with non-pharmacological interventions like exercise. Comparisons of the effect of medical and non-pharmacological treatment are also required to evaluate whether there are detrimental effects specific to medical, or indeed non- pharmacological treatments. Furthermore, some multiple risk factors interventions use medical and non- pharmacological interventions so it is useful to know the level of their effects. For example, drugs like ion-exchange resins, fibrates, niacin and statins are used in lowering cholesterol levels (coronary prevention group, 1991).
However, this approach can only be applied in the areas of high blood pressure and cholesterol lowering where both medical and non-pharmacological interventions may be used.
This approach values preventive medical procedures; therefore, there are medical professionals who ensure that the patients comply with recommended procedures. These health professionals include; doctors, surgeries, medical assistants, pharmacists, chemists, health visitors, government, and nurses.
It is the medical professional’s responsibility to ensure that patients comply with recommended procedures.
Another prominent and important approach to health promotion is the behavioural change approach.

This approach aims to change people’s individual attitude and behaviour, so that they adopt a healthy lifestyle. Promoting healthier lifestyles is an essential part of the wider action needed to address the personal, social and economic factors that affect people’s health. Targeted health promotion programmes like Active Lifestyle Task Force can address specific risks to health or can help specific groups within the population to improve their health. They are also vehicles for delivering against the aims of wider action to prevent heart disease and cancers, for example, the National Service Frameworks. Examples include teaching people how to stop smoking, educate about sensible drinking. The health professionals do this through persuasion, one-one advice, information, or mass campaigns, e.g. look after your heart campaign. The health professionals involved are community pharmacists, dieticians, government, Heart disease can occur as a result of diet, lack of physical activity, alcohol consumption and smoking. Therefore, the use of behavioural techniques can be applied. Behavioural technique to control coronary heart disease includes physical activity, good diet, and abstinence from smoking and alcohol. Making healthy food choices is one important thing that can be done to reduce the risk of heart disease. As a result, the government initiated the eat-well plate and other publications which show the different types of food needed to eat, and in what proportion, to have a well-balanced diet for the heart. Research has shown that physical activity – sport and exercise – is fundamental for a healthy lifestyle and helps to reduce people’s risks of developing coronary heart disease as well as reducing risk after coronary heart disease has become manifest . Smoking also increases the risk of developing cardiovascular diseases, which includes coronary heart disease and stroke. It damages the heart in so many ways, which makes the heart work harder and consequently, weaker. Therefore, government has provided help to smokers to help them quit, by outlining eight practical, quick and simple steps that can be taken straight away to quit smoking.
Those using this approach will be convinced that a healthy lifestyle is in the best interests of the clients, and will see it as their responsibility to encourage as many people as possible to adopt the healthy lifestyle they advocate.
Finally, the societal-change approach is another approach that will be analysed and explained in this essay.

The societal change approach aims at effecting changes in the physical, social and economic environment, in order to make it more conductive and supportive to good health. Methods of societal change approach include development of organizational policy, e.g. hospital catering policy Public health legislation, e.g. food labelling. Fiscal controls, e.g. subsidy to farmers to produce lean meat. Contrary to the behavioural change approach, the focus is on changing the society, not the behaviour of the individuals. Public health legislation like food labelling, for example, is a very significant societal change approach to health promotion on coronary heart disease. Most of the information on the food label was chosen based on studies of heart disease and diet. When eating for a healthy heart, factors that should be looked at include food labels to enable the individual to plan their portions and Number of Servings per Container. If a person is overweight or has trouble maintaining a healthy weight, keeping to a calorie control diet is important. Excess weight is a significant risk factor for heart disease. Government recommends most women should average about 1,800 to 2,000 calories a day – and even less, about 1,700 calories, if trying to lose weight. Most men should consume about 2,500 calories. Those numbers vary based on how active the individual is. However, Food labels should list all fats, not just the saturated kind, to help reduce rates of heart disease. Trans fats for instance, increase cholesterol and the risk of coronary heart disease. Hence, helping consumers spot which products contain Trans fatty acids - or trans fats - could cut the risk of heart disease, according to a British Medical Journal (BMJ) article. The health professionals involved here include, food manufacturers, government, shop owners Those using this approach will value their democratic right to change society; will be committed to putting health on the political agenda at all levels and to the importance of shaping the health environment rather than shaping the individual.

As mentioned earlier in the report, health promotion is, by its very nature, a normative and an acculturative enterprise, and can result to ethical dilemmas. It is normative because it proposes or recommends norms about what is considered good health, what is acceptable or unacceptable risk, and what is a healthy physical and social environment. Ethics in health promotion involves applying a critical analytic gaze to a particular programme or policy. There are some domains in which the ethical acceptability of health promotion interventions is questioned because it may interfere with fundamental cultural values or ethical principles. They include; autonomy and information communication. One of the fundamental principles of medical ethics in most western countries is respect for individual autonomy, individual liberty and private life but the application of this requirement becomes problematic when it is the consent of the individual that is at stake.
In addition, some paternalistic interventions of health promotion, to some extent, restrict or limit individual liberties. In the name of protecting the public good, public health institutions have deployed coercive methods such as prohibitions of certain behaviours (e.g., smoking indoors), mandatory participation (e.g., in vaccination, fluoridation), or aggressive health promotion campaigns. While effective in many contexts, such paternalistic interventions also, to various degrees, impinge upon or limit individual liberties. So another ethical issue for health promotion is the appropriate u se of soft and hard paternalist methods.
However, while the medical approach seeks to increase medical interventions and compliance; it ignores social and environmental factors that also affect health. The behavioural approach changes behaviour, but it is victim-blaming and also ignores social and economic factors. The societal-change approach, on its part, may require major structural changes. It is vulnerable to official oppositions.
In conclusion, health promotion makes efforts to enhance positive health and prevent ill-health, through the overlapping spheres of health education, prevention and health protection and emphasizes its role in the promotion of well-being rather than the prevention of disease.
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